In this study, we made retrospective analysis of clinical and pathological data from 714 patients with papillary thyroid cancer, presented and operated at the Department of ENT/Head and Neck Surgery, Sisters of Charity University Hospital, Zagreb, during the period from 1980 to 2008. All patients were operated with total thyreoidectomy with or without some type of lymph node neck dissection (paratracheal or lateral). There were 321 cases of papillary microcarcinoma (tumors less than or equal to 1 centimeter). We investigated the clinical and pathological characteristics of papillary microcarcinoma and compared this group with tumors larger than 1 centimeter. In comparison with their larger counterparts, groups >1-2 cm and >1-3 cm, microcarcinomas showed statistically less frequent aggressive behaviour, multicentric focuses, and less affinity for regional metastatic dissemination. Male gender and age less than 45 years were identified as unfavorable parameters of papillary microcarcinoma. In males, microcarcinoma had similar characteristics as larger tumours. Patients with coexisting Hashimoto thyreoiditis showed better behaviour according to our chosen clinical and pathological parameters. Multivariant analysis revealed intraglandular dissemination in contralateral lobe, male gender as an independent risk factor for developing metastasis. Nodular goiter has been identified as a protective parameter for metastasis. Even though our study identified microcarcinoma as tumour with better clinical and pathological characteristics than larger tumours, we can conclude that papillary thyroid microcarcinoma behaves in many ways similar to its larger counterparts and therefore recommend a similar clinical approach to them consequently.