Objective To summarize the latest research progress on the relationship between cN0 multifocal papillary thyroid microcarcinoma (PTMC) and central lymph node metastasis (CLNM) at home and abroad, so as to provide a reference for surgeons to balance the benefits and risks of surgery and select the best treatment plan. Method The latest studies on the relationship between CLNM and tumor characteristics of cN0 multifocal PTMC (including number of tumor foci, total tumor diameter, primary tumor diameter, total tumor surface area, etc.) were reviewed. Results Current domestic and international guidelines differ on whether cN0 PTMC should be used to prevent central lymph node dissection (pCLND). Proponents believe that pCLND could reduce the recurrence rate of disease and facilitate postoperative risk stratification and management under the premise of technical support. Opponents argue that it was not clear whether pCLND actually improves the prognosis of PTMC patients, but postoperative complications do correlate with pCLND. In order to guide the application of pCLND in the surgical treatment of cN0 PTMC, a large number of studies had reported the risk factors of CLNM in PTMC in recent years, among which multifocal was considered to be a very important risk factor for CLNM. In order to further understand the internal relationship between multifocal PTMC and CLNM, scholars at home and abroad quantified the feature of multifocal PTMC into various parameters, and studied the relationship between them and CLNM in multiple dimensions. It was found that total tumor diameter >1 cm, increased tumor number, total tumor surface area >3.14 cm2, diameter ratio <0.56, tumor volume >90 mm3 and bilateral multifocal PTMC might be the risk factors for increased CLNM risk in patients with cN0 multifocal PTMC. Conclusion These screened parameters are initially considered to be effective tools for predicting the risk of CLNM in multifocal PTMC. Multiple risk parameters coexist, especially in patients with multifocal PTMC characterized by bilateral intralar multifocal PTMC, who are expected to benefit more from pCLND. However, a large number of clinical studies are still needed to provide reliable evidence-based evidence for clinical diagnosis and treatment. In the future, by combining these valuable parameters, a scoring system can be constructed to predict the disease status of multifocal PTMC more accurately and identify patients with necessary pCLND, which will be of great significance for the appropriate treatment of PTMC.