Objective To analyze the related risk factors of lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC)patients. Methods The medical records and sonographic data of 208 patients with PTC received surgical treatment from January 2014 to January 2017 in our hospital were collected. The relationships between PTC patients LLNM and, the central lymph node metastasis (CLNM), relationship with thyroid membrane, bilateral, maximum diameter, multifocal, calcification, location, age ,gender was analyzed retrospectively.Results Binary logistic stepwise regression analysis show that the CLNM, relationship with thyroid membrane, multifocal, located at the upper pole, rich blood flow signals on the edge and inside of the tumor are the risk factors of LLNM in PTC patients, established regression equation, when the predicted probability of P≥0.33, its diagnostic sensitivity, specificity was 92.2% and 79.7% respectively, the area under the curve (AUC) is 0.923. When the number of CLNM≥ 3, its diagnosis sensitivity, specificity was 79.7% and 91.6% respectively, the AUC is 0.915;the rate of CLNM≥0.37, its diagnosis sensitivity, specificity was 87.5% and 79.0% respectively, the AUC is 0.882 . Conclusions Preoperative assessment of the risk of LLNM in patients with PTC by preoperative ultrasound is of great significance in guiding the clinical decision on the treatment of lateral lymph node dissection.