This study covers a large cohort of patients (3,029 cases) who underwent thyroid surgery under intraoperative nerve monitoring (IONM). Most common problems and complications associated with the surgery were identified and analyzed. On the basis of this analysis, we provide some practical advices and suggestions which specialists in the field will find useful in their surgical practice. The data will help in developing clear surgical guidelines for thyroid surgery with IONM and for post-operative follow-up and monitoring.