Purpose: Tall cell papillary thyroid carcinoma (PTC) is considered to be more aggressive than the classical variant of PTC, with greater incidence of recurrence and nodal metastasis. Papillary microcarcinoma (mPTC), defined as PTC ≤ 1cm in diameter, is considered to be indolent in a majority of cases. The objective of this study was to determine if tall cell mPTC are of increased risk of recurrence or metastasis. Methodology: This multicentre, retrospective cohort study utilised data from a prospectively maintained Western Australian surgical database. Patients who underwent thyroidectomy with histologically confirmed mPTC were included. Data collected included histological subtype, patient age and gender, extrathyroidal extension, lymphovascular invasion, nodal metastasis, recurrence and whether the cancer was advanced (defined as stage III or IV). Outcomes were compared with student’s t-test, chi squared test or Fisher’s Exact test as appropriate. Results: 144 patients were diagnosed with mPTC during the study period. 93 (64.6%) were classical subtype while 51 (35.4%) were tall cell. 41.8% of patients with classical mPTC had lymph node metastasis compared to 26.3% of tall cell mPTC, although this did not reach statistical significance. There was no recurrence in either group. There were no significant differences between groups in any of the outcomes analysed. Conclusion: In contrast with larger PTC, tall cell subtype mPTC is not associated with higher risk histological features or an increased risk of metastasis. Incidentally diagnosed tall cell mPTC does not require a change in management strategy compared to classical variant.