PURPOSE: For small papillary thyroid cancers (PTCs) with no lateral nodal involvement, American Thyroid Association guidelines recommend performing prophylactic central lymph node dissection (CLND) if it influences further management. This binational study explored the extent CLND affects subsequent therapy, including completion thyroidectomy and adjuvant radioactive iodine (RAI) ablation, in patients with small PTC. METHODOLOGY: Adults with small papillary thyroid cancers (≤4cm) were recruited from 42 institutions through the Australian & New Zealand Thyroid Cancer Registry (ANZTCR), between 2017 and 2023. Patients were excluded if they had clinical nodal involvement. The rate of completion thyroidectomy, RAI ablation and surgical complications were compared between patients with and without CLND. RESULTS: Of 1,636 patients with small PTCs (78% female; mean age 51 years), prophylactic CLND was performed for 747 patients (46%). Of those treated with a hemithyroidectomy (n=747), the rate of completion thyroidectomies was similar between patients with and without CLND at the index operation (p=0.34). However, CLND was associated with a 10% lower risk of the patient being recommended RAI ablation (adjusted relative risk [aRR] 0.90; 95% CI 0.86-0.94; p<0.001). Furthermore, CLND did not result in increased recurrent laryngeal nerve injury (p=0.36), permanent hypoparathyroidism (p=0.23) or return to theatre (p=0.86). CONCLUSION: From the surgeon reported cases of low risk PTC across Australia and New Zealand, prophylactic CLND for T1, T2 papillary thyroid cancers reduced subsequent RAI therapy, even though it did not influence subsequent completion thyroidectomy. There were no additional risks of surgical complications post CLND.