Recurrent laryngeal nerve (RLN) injury is a common and serious complication of thyroid surgery. Especially in complicated or re-operative thyroid surgery, the risk of RLN injury is always increased due to indistinct anatomical planes and anatomic variations of RLN. Intraoperative neuromonitoring (IONM) is a technology for identifying the integrity of nerves during operation by electrophysiological means, and recent studies demonstrated that IONM of RLN can significantly reduce the chance of transient and permanent RLN injury compared to conventional RLN exposure in thyroid surgery. The authors address the application and progress of IONM technology in thyroid surgery.