The introduction of intraoperative nerve monitoring (IONM) of the recurrent laryngeal nerve and superior laryngeal nerve in surgical practice was a milestone in thyroid surgery, increasing the safety of the procedures with the potential abolition of the most feared complication, the bilateral nerve lesion. Despite the unequivocal advantages of neuromonitoring, most of the studies were unable to demonstrate a statistically significant decrease in nerve lesions compared with nerve visualization alone. That fact, associated with the non-neglectable increase in the costs, has precluded the universal adoption of intraoperative nerve monitoring in thyroid surgery. There are, however, situations of increased risk of nerve lesions where the indication for neuromonitoring is almost absolute. In this chapter, we review the advantages of using IONM, namely, the pros and cons of its use in all thyroid surgery cases.