Objective: To investigate the clinical features as well as diagnosis and treatment strategies of differentiated thyroid microcarcinoma (TMC). Methods: The clinical data of 138 patients with differentiated TMC confirmed by surgical and pathological findings from January 2007 to December 2013 were reviewed, and were comparatively analyzed with the data of 29 patients with benign thyroid nodules who during the same period of time underwent surgery with the suspicion of thyroid cancer. Results: Of the 138 TMC patients, 131 cases were papillary TMC, 5 cases were follicular TMC, and 2 cases were mixed TMC; 49 cases were complicated with nodular goiter, 5 cases with nodular goiter and Hashimoto’s thyroiditis, 7 cases with Hashimoto’s thyroiditis, and 2 cases with hyperthyroidism. In TMC patients, the malignancy diagnostic rate by TI-RADS classification, and the incidence of gravel-like calcification and malignancy diagnostic rate by contrast-enhanced ultrasound were all significantly higher than those that in BTN patients (all P<0.05). All the TMC patients underwent intraoperative rapid pathological assessment, 84 cases underwent ipsilateral thyroidectomy, 46 cases underwent ipsilateral thyroidectomy plus contralateral partial thyroidectomy, 5 cases underwent bilateral total thyroidectomy, and 3 cases underwent ipsilateral thyroidectomy plus contralateral subtotal thyroidectomy; 85 cases received central lymph node dissection and 3 cases had additional ipsilateral functional neck dissection. All the TMC patients were prescribed lifelong thyroxine therapy after surgery. Conclusion: High-resolution ultrasound combined with TI-RADS or contrast-enhanced ultrasound can improve the detection rate of TMC. Well-differentiated papillary thyroid cancer and high calcification rate is frequently seen in TMC, and ipsilateral thyroidectomy plus isthmectomy with simultaneous central cervical lymph node dissection is the major surgical procedure for TMC.