OBJECTIVE: The objective of the present study was to analyze the surgical safety of retaining the glands in papillary thyroid microcarcinoma (mPTC). PATIENTS AND METHODS: 156 cases of mPTC were retrospectively reviewed and divided into four groups according to the treatment: group A (conservative follow-up group, 30 cases), group B (total resection of unilateral gland combined with isthmic resection, 48 cases), group C (total resection of unilateral gland combined with subtotal resection of contralateral gland, 47 cases), and group D (total resection of bilateral glands, 31 cases). The average follow-up time was 34.5 months. RESULTS: The occurrence rate of hypothyroidism, hypoparathyroidism, hypocalcemia, injury of the recurrent laryngeal nerve and total occurrence rate in the group B were significantly lower than in the group C and group D, and the differences were statistically significant (p<0.05). The 75% survival time was 33 months in group A, 35 months in group B, and 34 months in group D. The survival time of group A was significantly less than in the other groups, and the difference was statistically significant (p0.05). CONCLUSIONS: The total resection of the unilateral gland combined with isthmic resection, which conserves gland functionality, reduces complications and maintains survival time. It is, therefore, worthy of further clinical application.