Thyroidectomy is one among the most commonly performed endocrine surgeries. Iatrogenic injury of the recurrent laryngeal nerve (RLN) is of major concern in thyroid surgery. We report the case of a 37-year-old female with papillary carcinoma of thyroid posted for total thyroidectomy. Although direct identification of the nerve is considered as the gold standard, we discuss the intraoperative monitoring of RLN using electromyography endotracheal tube and its anaesthetic considerations.