Objectives: To assess the relation between use of Intraoperative nerve monitoring (IONM) in thyroid surgery and the prevalence of RLN injury, and to assess its significance of IONM in reduction of RLN injury among patients who underwent thyroid surgery. Background: Recurrent laryngeal nerve (RLN) palsy is one of the big concerns for surgeons during thyroid surgery. Surgeons tried to find ways to identify this nerve and preserve it. The most popularly used way is the use of Intraoperative nerve monitoring (IONM). Methods: In this retrospective study, we collected the data for all cases that underwent thyroid surgery in Security Forces Hospital (SFH), Riyadh, Saudi Arabia during the period of 2010 to 2012. We divided participants to two groups, those who used IONM and those who did not used IONM. The statistical Package for Social Sciences (SPSS, version 22) was utilized for data entry and analysis. Categorical variables were described by frequencies and percentages. Descriptive analysis involving Chi-square test was used to test significance of association between categorical variables. The level of significance was set at P< 0.05. Results: Post-operation RLN injury was higher in those who underwent thyroid surgery without IONM, but the difference was insignificant (p=0.460). Three of those patients who underwent the surgery without IONM has RLN injury (3.1%), and no RLN injury reported of those who underwent surgery with IONM (0%). Conclusion: IONM could help in identifying the RLN and preserving it from injury. Although, in this study there were insignificant correlations between RLN injury and IONM. Further researches on a larger-scales is recommended to get more informative results and allow better comparison.