Abstract Introduction The 2015 American Thyroid Association guidelines recommend to de‐escalate treatment such as Thyroid lobectomy instead of total thyroidectomy for 1–4 cm papillary thyroid cancer (PTC). Dutch guidelines endorse restricted work‐up for thyroid incidentalomas recommending only fine needle aspiration in case of a ‘palpable thyroid nodule’. This diagnostic work‐up algorithm may result in the identification of less indolent PTCs and may lead to a patient population with relatively more aggressive PTCs. This study aims to retrospectively analyze recurrence rates of low‐risk 1–4 cm PTC in the Netherlands. Methods From the national cancer registry, patients with low‐risk 1–4 cm PTC between 2005 and 2015 were included for analysis. Disease free survival (DFS) and overall survival were compared between patients who underwent TT ± RAI and TL without RAI. Post‐hoc propensity score analysis was performed correcting for age, sex, T‐stage, and N‐stage. Results In total 901 patients were included, of which 711 (78.9%) were females, with a median follow‐up of 7.7 years. TT was performed in 893 (94.8%) patients. Recurrence occurred in 23 (2.6%) patients. Multivariable analysis showed no significant correlation between extent of surgery and DFS ( p = 0.978), or overall survival ( p = 0.590). After propensity score matching, multivariable analysis showed no significant difference on extent of surgery and recurrence. Conclusion Low‐risk PTC patients with 1–4 cm tumor who underwent TL showed similar recurrence rates as those who underwent TT ± adjuvant RAI, which suggests that TL can be sufficient in treating low‐risk 1–4 cm PTC, possibly reducing morbidity of these patients in the Netherlands.