Intraoperative neuromonitoring during thyroidectomy has become a tool available to modern thyroid surgeons. There is ongoing debate as to its effectiveness in reducing intraoperative complications, particularly vocal cord paresis and paralysis. Proponents of its use believe it increases the safety of performing thyroidectomy by improving the ability to identify and preserve the recurrent and superior laryngeal nerves. Some surgeons use it in every case, some only in selected more complicated cases and some choose not to use it at all. There are many reasons why surgeons choose to use or not use this new technology. There are no current consensus guidelines for using intraoperative neuromonitoring and the technology continues to evolve. In this article, we will outline the current scientific literature surrounding the use of neuromonitoring in thyroid surgery and will attempt to give an unbiased current assessment of this technology that is available to actively practicing thyroid surgeons.