Objective To investigate the clinical effect of recurrent laryngeal nerve monitoring in bilateral total thyroidectomy. Methods The study subjects were 80 patients with thyroid cancer who underwent bilateral total thyroidectomy in Jiangmen People's Hospital from March 2022 to March 2023. They were evenly divided into two groups according to whether recurrent laryngeal nerve monitoring was used during the operation, namely, 40 patients who did not undergo recurrent laryngeal nerve monitoring during the operation were classified into the control group, and the other 40 patients with recurrent laryngeal nerve monitoring during the operation were classified into the observation group. Clinical indicators and recurrent laryngeal nerve injury were compared between the two groups. Results There was no significant difference （P>0.05） in intraoperative bleeding volume and drainage volume between the two groups. The exploration time and surgical time of recurrent laryngeal nerve of the observation group [（6.73±2.46） min and （102.35±18.48） min] were significantly shorter than those of the control group [（9.17±3.54） min and （113.27±16.85） min] （P<0.05）. Compared with the control group, the observation group had significantly lower incidence rates of temporary recurrent laryngeal nerve injury and permanent recurrent laryngeal nerve injury （P<0.05）. Conclusion For patients with thyroid cancer, monitoring of recurrent laryngeal nerve during bilateral total thyroidectomy can not only effectively shorten the exploration time and operation time of recurrent laryngeal nerve, but also effectively reduce the occurrence of temporary and permanent recurrent laryngeal nerve injury.