The integration of intraoperative nerve monitoring (IONM) in thyroid surgery has revolutionized the detection and prevention of recurrent laryngeal nerve (RLN) injuries, which are critical for vocal cord function. Despite historical challenges, the application of IONM has significantly improved patient outcomes by reducing complications such as vocal cord paralysis (VCP). This chapter explores the phenomenon of true loss of signal (LOS) during neuromonitoring, examining its causes, risk factors, and clinical significance. Additionally, it outlines management strategies and a troubleshooting algorithm designed to mitigate nerve injury. Emphasis is placed on the importance of adhering to strict IONM protocols to enhance surgical safety and efficacy, aiming to improve patient care in thyroid and parathyroid surgeries.