Background <p>Invasion of the recurrent laryngeal nerve (RLN) by thyroid carcinoma presents a challenging intraoperative decision that requires balancing oncologic clearance with preservation of laryngeal function. Evidence guiding surgical decision-making in this setting remains limited.</p> Methods <p>We performed a retrospective observational study of patients undergoing thyroidectomy between 2018 and 2023 in whom RLN invasion was identified intraoperatively. Management strategies included partial layer resection (PLR) with nerve preservation or nerve reconstruction following nerve sacrifice. Reconstruction techniques included ansa cervicalis–RLN anastomosis (ARA), direct end-to-end anastomosis (DA), and nerve–muscle pedicle transfer (NMP). Oncologic and functional outcomes were evaluated. Based on observed surgical decision patterns, an intraoperative management algorithm was developed.</p> Results <p>Twenty-nine patients with RLN invasion were included. Preoperative vocal cord mobility was preserved in 89.6% of patients. RLN preservation using PLR was performed in 18 patients (62.1%), while 11 patients (37.9%) underwent nerve reconstruction. Median disease-free survival was not reached. Five recurrence events occurred, all within the lateral neck compartment; no recurrence occurred at the site of RLN preservation or reconstruction. Functional outcomes were favourable. Vocal fold mobility was preserved in 83.3% of patients following PLR. Reconstruction procedures resulted in improved vocal fold tone and glottic closure. The highest mean maximum phonation time was observed in the PLR group (12.8&#xa0;s).</p> Conclusion <p>Selective RLN preservation when feasible and reconstruction when necessary can achieve satisfactory oncologic control while maintaining meaningful postoperative laryngeal function. The proposed intraoperative decision algorithm provides a practical framework to guide surgical management when RLN invasion is encountered.</p>