Recurrent laryngeal nerve (RLN) injury after thyroid surgery is one of the most feared complications surgeons and patients must deal with. Visual identification of the RLN remains the gold standard of care during thyroid surgery to reduce postoperative nerve palsy. However, visualization alone may not be sufficient, so intraoperative nerve monitoring (IONM) has become increasingly used in recent years. IONM assists surgeons in the visual identification and dissection of the RLN and external branch of the superior laryngeal nerve (EBSLN), predicts vocal cord function in the postoperative period, prevents bilateral vocal cord paralysis (bVCP), and is associated with fewer postoperative RLN palsies and fewer postoperative voice changes. IONM is safe and feasible. The authors believe IONM should be considered in all patients undergoing thyroid surgery.