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8% vs. 80.6%, p = 0.199). Multivariate analysis indicated that the significant risk factors of LLNM include ETE (odds ratio [OR] 1.904, 95% confidence interval [CI] 1.267-2.861), multifocality (OR 2.255, 95% CI 1.544-3.293), and central node metastasis (OR 7.768, 95% CI 4.869-12.395), but not BRAF mutation (OR 0.542, 95% CI 0.337-0.874). CONCLUSION Approximately 4.4% of patients with PTMC presented with LLNM at the time of diagnosis. Moreover, the significant risk factors of LLNM include central node metastasis, ETE, and multifocal disea