The recent prevalence of ultrasonography (US) and US-guided fine needle aspiration biopsy (FNAB) can make us easily diagnose papillary carcinoma of 1.0 cm or less in maximal diameter, which is called papillary microcarcinoma. In the face of the fact that cervical lymph node metastasis and multicentricity are two prominent clinical characteristics of papillary thyroid microcarcinoma, the question How to treat papillary microcarcinoma has given rise to controversy. In this review, we discuss the clinical behavior, the appropriate therapeutic strategies, the factors affecting prognosis, and the methods for following up the patients with papillary thyroid microcarcinoma.