Thyroid microcarcinoma is defined as thyroid cancer ≤ 10 mm in diameter and is usually papillary microcarcinoma (PMC). Despite recent increase in incidence, there is little consensus in management of thyroid microcarcinomas. This study aims to review the frequency of multifocality and lymph node (LN) metastasis, and the surgery performed on patients diagnosed with PMCs at the University of Oklahoma Medical center from 2004-2014. During this time, 20 PMCs were diagnosed at the Department of Pathology with tumor size ranging from 2 to 10 mm. Nine of 20 PMCs were treated with total thyroidectomies, of which 4 demonstrated multifocality. Two of 11 PMCs treated with lobectomies showed multifocal PMCs in the resected lobe. Seven of 20 cases had accompanying LN dissection with central compartment LNs in six cases, and lateral cervical LNs in three cases. Three of seven cases showed LN metastasis to central compartment with or without lateral cervical LN involvement with only one case showing contralateral LN metastasis. To summarize, multifocal PMCs were found in 30% (6/20) cases and LN metastasis (central and lateral cervical) was reported in 20% (4/20) cases. This data supports total thyroidectomy as the preferred treatment for PMCs with a conservative LN dissection approach limited to central compartment and/or palpable neck nodes.