Thyroid surgery is among the most frequent cases in anesthetic practice. Recently, besides open thyroidectomy, endoscopic and robotic thyroidectomies on selected patients and particularly surgical interventions performed under intraoperative nerve monitoring (IONM) to protect the laryngeal nerves have led to advancements in anesthetic approaches. Both endotracheal intubation with a special tube and the selection and dosing of anesthetics have gained importance in avoiding complications. The present section highlights the specific considerations in anesthesia management during thyroidectomy with IONM.