Extent of thyroidectomy for papillary thyroid carcinoma is still matter of debate. Indeed, recently, international guidelines endorsed thyroid lobectomy as initial surgical approach for low risk, small medium-sized (T1-T2), N0 papillary thyroid carcinoma in absence of extrathyroidal extension. When dealing with a conservative surgery for oncologic disease is of utmost importance to exclude effectively more advanced disease, which could benefit from a more aggressive initial operation. However, in the setting of surgery for papillary thyroid carcinoma, despite an accurate preoperative work up could led to identify some suspicious characteristics as macroscopic evidence of multifocality or extrathyroidal extension, and/or evidence of lateral neck lymph node metastases, it is difficult to reliably assess the central neck nodal status both pre- and intra-operatively. Frozen section examination of the central neck nodes ipsilateral to the side of the tumor has been proposed in patients scheduled for thyroid lobectomy, in order to modulate the extension of both thyroidectomy and central neck dissection. Future molecular and genetic evidences are needed to establish high-risk patients with small papillary thyroid carcinoma in which thyroid lobectomy could be not and adequate surgical treatment.