Objective <p>To analyze independent risk factors for distant metastasis of columnar cell subtype of papillary thyroid carcinoma (CCS-PTC) and to construct and validate a nomogram to help clinicians make more individualized clinical decisions.</p> Study design <p>Retrospective population-based cohort study.</p> Setting <p>Surveillance, Epidemiology, and End Results (SEER) database.</p> Methods <p>Patient data were downloaded from the SEER database. Chi-square test and Logistic regression analysis were used to determine independent risk factors for distant metastasis of CCS-PTC. A nomogram based on significant independent risk factors was established using the rms package of R software (version 4.3.3). The performance of the nomograms was evaluated using subject work characteristic curves (ROC), calibration curves, and decision curve analysis (DCA).</p> Results <p>A total of 1712 patients with CCS-PTC were included, of which 79 patients developed distant metastasis, accounting for 4.61% of the entire cohort. The results of chi-square test showed that age, gender, race, tumor size, and lymph node metastasis were significantly associated with distant metastasis of CCS-PTC. Multifactorial logistic regression analysis showed that age, race, tumor size, and lymph node metastasis were independent risk factors for distant metastasis of CCS-PTC, and this was used to draw the nomogram. the results of ROC, calibration curves, and DCA showed that the predictive performance of the nomogram was good.</p> Conclusion <p>We successfully constructed and validated a nomogram for CCS-PTC distant metastases, which is important for clinicians to identify patients at high risk of distant metastases in a timely manner and make more individualized clinical decisions.</p>