KQ 13.1. Intraoperative neuromonitoring (IONM) during thyroid surgery may be beneficial in identifying and preserving the recurrent laryngeal nerve (RLN) or external branch of the superior laryngeal nerve (EBSLN). False positive or false negative outcomes during IONM have been considered limitations. To minimize such failures, experts in IONM have suggested following the standardized procedure of IONM and the troubleshooting algorithm. KQ 13.2. Damage to the EBSLN leads to alterations in the voice quality, particularly at higher pitch ranges. Owing to the lack of effective treatments for EBSLN injuries, the prevention of such injuries is important. KQ 13.3. As the prognosis of well-differentiated thyroid cancer is highly favorable, preserving the RLN is crucial for maintaining the patient’s quality of life. Medialization thyroplasty with or without arytenoid adduction is the primary standard treatment. Injection laryngoplasty (IL) has recently gained popularity due to its ease and safety under local anesthesia. Primary intraoperative RLN reinnervation offers several advantages over medialization thyroplasty and IL, such as maintaining long-term tension and volume of the reinnervated thyroarytenoid muscle. KQ 13.4. Post-thyroidectomy hypoparathyroidism arises from devascularization or inadvertent resection of the parathyroid glands. Identifying the parathyroid gland and preserving its blood vessels are critical for maintaining gland function.