Objective: To determine the risk factors for cervical lymph node metastasis and the scope of lymph node dissection in thyroid microcarcinoma (TMC). Methods: The clinical data of 269 TMC patients admitted from January 2009 to June 2013 were retrospectively analyzed. Of the patients, all cases underwent primary lesion resection plus central lymph node dissection and 27 cases underwent lateral cervical dissection. The relations of each clinicopathologic factor of the patients with cervical lymph node metastasis were analyzed. Results: Among the 269 patients, 107 cases (39.8%) had cervical lymph node metastasis, of whom 103 cases (96.3%) had central lymph node metastasis and 25 cases (23.4%) had lateral cervical lymph node metastasis. Univariate analysis showed that male sex, tumor size >5.0 mm and extrathyroidal invasion were significantly associated with cervical lymph nodes metastasis of TMC (all P<0.05); multivariate analysis identified that tumor size>5.0 mm (OR=3.358, P<0.05) and extrathyroidal invasion (OR=5.230, P<0.05) were independent risk factors for cervical lymph nodes metastasis. Conclusion: In TMC patients with tumor size >5.0 mm or extrathyroidal invasion, the incidence of central lymph node metastasis is increased and, in these cases, central lymph node dissection is necessary.