Objective. The strategy of active surveillance for papillary thyroid microcarcinoma (PTMC) is currently becoming more popular in the global medical community. The pivotal criterion for choosing the active surveillance strategy is the absence of any signs of lymphogenic or distant metastases. In the present work, we assessed the diagnostic accuracy of molecular genetic markers in predicting the metastatic potential in patients with PTMC. Methods. The expression level of 33 molecular genetic markers in cytology samples from 92 patients with PTMC with the known histological diagnosis, including 32 with metastases to regional cervical lymph nodes, was assessed. The list included 22 genes and 11 microRNAs. The presence of the somatic BRAF V600E mutation was investigated separately. Results. In patients with metastatic PTMC, the HMGA2 gene, the TIMP1 gene, and the FN1 gene were more active, and microRNA-146b expression was upregulated. Downregulated expression of microRNA-7 and -148b was also detected in metastatic tumors, which is indicative of their tumor suppressor role. Metastatic tumors were characterized by on average 11-fold lower activity of DIO1, eightfold lower expression of the TFF3 gene, fourfold lower expression of TPO. All the markers, except for BRAF mutation, have high sensitivity (84.5–90.6%) for detecting metastatic PTMC but low specificity (~ 50%). Conclusions. Application of molecular markers for predicting lymphogenic metastatic spread in patients with PTMC can possibly supplement the existing risk grading systems. These studies are relatively simple to conduct and available as early as at the preoperative stage.