Background <p>Papillary thyroid carcinoma, which constitutes up to 80% of all thyroid cancer cases, is recognized as a well-differentiated and usually slow-growing malignancy with 40–70% lymph node metastasis in the central neck. This work aimed to evaluate short term outcomes of the prophylactic central compartment neck dissection in patients diagnosed with papillary thyroid carcinoma.</p> Methods <p>This prospective randomized study involved 70 patients who had papillary thyroid carcinoma in Tanta University Hospitals. All patients were divided into 2 groups: Group A (Study group) (<i>n</i> = 35): underwent total thyroidectomy (TT) and concomitant prophylactic bilateral central compartment neck dissection (CCND) and Group B (Control group) (<i>n</i> = 35): underwent TT only.</p> Results <p>Temporary HPT was observed in 29% of patients in Group A compared to 8.8% in Group B, permanent HPT was observed in 16.1% of Group A patients but was absent in Group B. No significant differences were found regarding temporary and permanent vocal cord paralysis. Regression Analysis was done to determine factors affecting permanent hypoparathyroidism (HPT) and permanent vocal fold palsy, extrathyroid extension is the only variable significantly associated with permanent HPT (p=0.021), with a markedly elevated risk (OR=14.462). T4 tumor stage and vascular invasion show elevated odds ratios for permanent HPT and permanent vocal fold palsy but without statistical significance.</p> Conclusions <p>These findings suggest that prophylactic CCND should not be routinely performed due to a higher risk of complications, particularly hypoparathyroidism.</p>