With the popularization of intraoperative nerve monitoring (IONM) , it is possible to determine the intraoperative nerve function, which provides evidence-based basis for surgical decision making. Intraoperative loss of nerve signal (LOS) often indicates postoperative vocal cord dyskinesia. Once LOS occurs intraoperatively, the next surgical strategy adopted by the operator has always been controversial among Chinese and western experts. Therefore, this paper makes a comparative analysis of the differences between the viewpoints of domestic experts and western scholars and the possible causes through the investigation of domestic and foreign literature to provide theoretical basis for better thyroid surgery decision.