Thyroid surgery rates have tripled over the past three decades, making it one of the most frequently performed procedures in general surgery. Postoperative complications, such as recurrent laryngeal nerve (RLN) palsy and external branch of the superior laryngeal nerve (EBSLN) palsy, significantly impact patients' quality of life. The introduction of neuromonitoring in thyroid surgery, which confirms anatomical integrity and assesses laryngeal nerve function, has been a milestone. The International Neural Monitoring Study Group (INMSG) has standardized RLN and EBSLN monitoring techniques, increasing the prevalence of neural monitoring during thyroidectomy. Neuromonitoring allows for the assessment of nerve function during surgery, enabling surgeons to avoid bilateral vocal fold paresis by performing staged thyroidectomy if unilateral nerve injury is detected. The most common system for intraoperative neuromonitoring uses an endotracheal tube with built-in surface electrodes, which detect electromyographic (EMG) responses from vocal muscles after electrical stimulation of the laryngeal nerves. Continuous intraoperative neuromonitoring (C-IONM) offers real-time monitoring and can prevent unilateral vocal fold paresis due to traction. The use of neuromonitoring has reduced the rate of RLN injury, with studies showing lower rates of transient and permanent paresis compared to visual identification alone. Continuous IONM has been shown to be superior to intermittent IONM in preventing vocal cord palsy, with a 1.7-fold lower early postoperative vocal cord palsy rate and a 30-fold lower permanent vocal cord palsy rate. Neuromonitoring also improves the identification rate of the EBSLN and reduces the risk of early phonation changes after thyroidectomy. It provides medical documentation confirming the proper function of the RLN and facilitates postoperative communication with patients about voice disorders. The safety of intraoperative neuromonitoring is well-established, with rare complications related to electrode displacement, endotracheal tube obstruction, or anesthetic drugs. The technique is widely used in Europe, with 85.2% of thyroid surgeries in Europe using IONM in 2022, primarily with intermittent IONM (87.1%). In conclusion, neuromonitoring of the laryngeal nerves has become a standard in thyroid surgery, enhancing safety, precision, and patient outcomes.Thyroid surgery rates have tripled over the past three decades, making it one of the most frequently performed procedures in general surgery. Postoperative complications, such as recurrent laryngeal nerve (RLN) palsy and external branch of the superior laryngeal nerve (EBSLN) palsy, significantly impact patients' quality of life. The introduction of neuromonitoring in thyroid surgery, which confirms anatomical integrity and assesses laryngeal nerve function, has been a milestone. The International Neural Monitoring Study Group (INMSG) has standardized RLN and EBSLN monitoring techniques, increasing the prevalence of neural monitoring during thyroidectomy. Neuromonitoring allows for the assessment of nerve function during surgery, enabling surgeons to avoid bilateral vocal fold paresis by performing staged thyroidectomy if unilateral nerve injury is detected. The most common system for intraoperative neuromonitoring uses an endotracheal tube with built-in surface electrodes, which detect electromyographic (EMG) responses from vocal muscles after electrical stimulation of the laryngeal nerves. Continuous intraoperative neuromonitoring (C-IONM) offers real-time monitoring and can prevent unilateral vocal fold paresis due to traction. The use of neuromonitoring has reduced the rate of RLN injury, with studies showing lower rates of transient and permanent paresis compared to visual identification alone. Continuous IONM has been shown to be superior to intermittent IONM in preventing vocal cord palsy, with a 1.7-fold lower early postoperative vocal cord palsy rate and a 30-fold lower permanent vocal cord palsy rate. Neuromonitoring also improves the identification rate of the EBSLN and reduces the risk of early phonation changes after thyroidectomy. It provides medical documentation confirming the proper function of the RLN and facilitates postoperative communication with patients about voice disorders. The safety of intraoperative neuromonitoring is well-established, with rare complications related to electrode displacement, endotracheal tube obstruction, or anesthetic drugs. The technique is widely used in Europe, with 85.2% of thyroid surgeries in Europe using IONM in 2022, primarily with intermittent IONM (87.1%). In conclusion, neuromonitoring of the laryngeal nerves has become a standard in thyroid surgery, enhancing safety, precision, and patient outcomes.