INTRODUCTION: Thyroid operations belong to the most frequent procedures in Germany (100,000/year). An important quality parameter is the incidence of postoperative recurrent nerve paralysis. Intraoperative identification by visualization of the nerve with a paralysis rate of 1% is the present gold standard in dedicated centers. PROBLEM: Can this results be further improved by use of an intraoperative neuromonitoring system (NM). RESULTS: The use of NM is helpful in difficult situations (recurrent goiter, advanced carcinoma, anatomic variants), but a quality improvement is not yet proven. CONCLUSION: NM can not replace the current nerve identification by meticulous preparation of anatomic structures. It should be used at the discretion of the operative surgeon.