Neuromonitoring in thyroid surgery has become a standard practice, significantly improving patient outcomes by reducing the risk of laryngeal nerve injuries. Over the past three decades, thyroid surgery rates have tripled, making it one of the most common procedures in general surgery. Serious complications, such as recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) palsy, are among the most common postoperative issues. RLN palsy can lead to voice loss, breathing difficulties, and even tracheostomy, while EBSLN injury often goes unnoticed and can cause voice changes. The introduction of intraoperative neuromonitoring (IONM) has revolutionized thyroid surgery by enabling real-time assessment of nerve function and anatomical integrity. The International Neural Monitoring Study Group (INMSG) has standardized IONM techniques, leading to widespread adoption. IONM allows surgeons to detect nerve injuries early, enabling staged thyroidectomy to prevent bilateral nerve damage. Continuous IONM (C-IONM) is more effective than intermittent IONM (I-IONM) in preventing nerve injury, as it allows for real-time monitoring and intervention. The use of IONM has been shown to reduce the incidence of RLN and EBSLN injuries, improve surgical outcomes, and enhance patient safety. Despite challenges in implementation, such as reimbursement issues, IONM is increasingly adopted globally, with over 85% of thyroid surgeries in Europe using IONM. The technique is considered safe, with minimal complications, and is recommended in guidelines worldwide. As IONM continues to evolve, it plays a crucial role in improving the safety and precision of thyroid surgery.Neuromonitoring in thyroid surgery has become a standard practice, significantly improving patient outcomes by reducing the risk of laryngeal nerve injuries. Over the past three decades, thyroid surgery rates have tripled, making it one of the most common procedures in general surgery. Serious complications, such as recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) palsy, are among the most common postoperative issues. RLN palsy can lead to voice loss, breathing difficulties, and even tracheostomy, while EBSLN injury often goes unnoticed and can cause voice changes. The introduction of intraoperative neuromonitoring (IONM) has revolutionized thyroid surgery by enabling real-time assessment of nerve function and anatomical integrity. The International Neural Monitoring Study Group (INMSG) has standardized IONM techniques, leading to widespread adoption. IONM allows surgeons to detect nerve injuries early, enabling staged thyroidectomy to prevent bilateral nerve damage. Continuous IONM (C-IONM) is more effective than intermittent IONM (I-IONM) in preventing nerve injury, as it allows for real-time monitoring and intervention. The use of IONM has been shown to reduce the incidence of RLN and EBSLN injuries, improve surgical outcomes, and enhance patient safety. Despite challenges in implementation, such as reimbursement issues, IONM is increasingly adopted globally, with over 85% of thyroid surgeries in Europe using IONM. The technique is considered safe, with minimal complications, and is recommended in guidelines worldwide. As IONM continues to evolve, it plays a crucial role in improving the safety and precision of thyroid surgery.