Background There is still a great controversy among oncologic surgeons regarding the role of lateral lymph node dissection in patients with papillary thyroid cancer, although tumors spread to this compartment have been established. To optimize the management of such patients, we intended to study the predictors for lateral lymph node metastasis (LLNM) in patients with papillary thyroid cancer. Patients and methods This study included 63 patients whose data were retrospectively reviewed. All of them underwent total thyroidectomy with central and lateral lymph node dissection. They were divided into two groups based on the final histopathological analysis: group A (LLNM +ve) and group B (LLNM -ve). Results The incidence of LLNM was 41.27%, making 26 patients included in group A, and the remaining 37 patients included in group B. Group A expressed younger age and higher prevalence of male sex. Operative time was statistically comparable between the two groups. Although group A had significantly larger tumors, other tumor criteria, including number, bilaterality, capsular, and extracapsular spread, showed no significant difference between the two groups. Nonetheless, upper-pole lesions, lymphovascular invasion, and the number of harvested and infiltrated central lymph nodes were significantly increased in group A. Although most of the significant factors maintained their significance on univariate analysis, only the central lymph node status remained significant on the multivariate one. Conclusion Younger age, male sex, larger tumors, upper-pole lesions, lymphovascular invasion, concomitant thyroiditis, and increased metastatic central lymph nodes are strongly associated with LLNM.