The thyroid gland, recurrent laryngeal and superior laryngeal nerve, and the inferior thyroid artery have such close relations that the knowledge of the usual anatomy and variations must be mastered to preserve the nerves. The thyroid gland can also vary in size (i.e., goiter) and distort the structure’s location. With knowledge of anatomical variations, careful dissection, and the use of neuromonitoring, the recurrent laryngeal and superior laryngeal nerve can be preserved, avoiding its damage.