Objective: To investigate the effect of intraoperative neuromonitoring (IOM) of the recurrent laryngeal nerve recurrent laryngeal nerve (RLN) in endoscopy-assisted thyroidectomy for early differentiated thyroid carcinoma (DTC). Methods: The clinical data of 180 patients with early DTC undergoing endoscopy-assisted thyroidectomy from June 2012 to January 2015 were retrospectively analyzed. Of the patients, 90 cases received IOM of RLN (monitoring group), and the other 80 cases did not receive IOM of RLN (non-monitoring group). The relevant surgical variables and the incidence of transient and permanent RLN injury between the two groups were compared. Results: In monitoring group compared with non-monitoring group, the mean operative time, intraoperative blood loss, postoperative drainage volume were significantly reduced [(90.2±20.2) min vs. (100.2±26.9) min; (16.3±13.2) mL vs. (24.4±9.8) mL; (25.5±8.5) mL vs. (29.7±5.6) mL, all P<0.05]; the number of removed lymph nodes and length of hospital stay showed no significant difference [(5.1±1.9) vs. (4.9±1.2); (3.8±2.5) d vs. (3.9±2.7) d, both P>0.05]. During a 12-week follow-up, the incidence of temporary RLN injury was 7.4% (8/105) in monitoring group and 19.0% (18/95) in non-monitoring group, and the difference had statistical significance (P<0.05), while incidence of permanent RLN damage was 1.0% (1/105) in monitoring group and 3.2% (3/95) in non-monitoring group which had no significant difference (P>0.05). Conclusion: Using IOM of RLN in endoscopy-assisted thyroidectomy for early DTC can effectively reduce the incidence of transient RLN injury, shorten the operative time and reduce intraoperative blood loss.