Introduction Thyroid papillary carcinoma is the most common type of thyroid cancer. Thyroid papillary microcarcinoma is a subtype of papillary carcinoma that includes tumors with 10 mm or less diameter. As a result of diagnostic methods improvement, prevalence of this tumor is increasing. In this study, we reviewed lymph node metastasis characteristics among patients with papillary microcarcinoma. Methods A retrospective study about 55 patients operated for a papillary microcarcinoma, at our institution, from 2000 to 2020. Results The average age of our patients was 48 years. The sex-ratio (H/F) was 0.17. The circumstances of the discovery were a metastatic cervical adenopathy in 5 cases, incidental on histological examination in 45 cases, on an echoguided fine needle aspiration in 5 cases. We performed a total thyroidectomy without lymph node dissection in 3 cases. A total thyroidectomy with central lymph node dissection was done in 39 cases, lateral and central lymph node dissection were performed in 5 cases. It was a two-stage thyroidectomy in 15 cases. Lobo-isthmectomy was performed in 6 cases, and a lobectomy (totalization) in 2 cases. Lymph node metastasis was diagnosed on the anatomopathological examination in 15 cases: 10 of them presented central lymph nodes metastasis, 5 of them presented central and lateral lymph nodes metastasis. Among those patients, the mean papillary microcarcinoma size was 8 mm. It was multifocal in 1 case, non-encapsulated in 8 cases, infiltrating perithyroid tissue in 10 cases. All patients, having lymph node metastasis, had radioactive iodine. No cases of recurrence or distant metastasis have been reported. Conclusion Papillary microcarcinoma has a benign behavior with excellent prognosis in most cases however lymph nodes metastases are frequent and seem to be correlated with tumor size, capsule, and multifocality.