Objective To explore the clinical value of exposing recurrent laryngeal nerve in high-risk thyroid surgery. Methods 100 cases of patients with high-risk thyroid surgery received and admitted to our hospital from January 2015 to 2016 December were selected clinically and divided into exposing nerve group (n=60 cases) and non-exposing group (n=40 cases) by having exposing recurrent laryngeal nerve or not in the operation to compare the clinical indexes of hospitalization cost, operation time, intraoperative bleeding, etc. and the postoperative adverse reactions of recurrent laryngeal nerve injury, and hypocalcemia, etc. in two groups. Results The hospitalization cost, operation time and intraoperative blood loss of exposing nerve group were significantly higher than those of non-exposing nerve group and the difference was statistically significant (P<0.05). The incidence of hypocalcemia was 2 in exposing nerve group (3.3%), and was 10 cases (25.0%) in non-exposing nerve group . There was significant difference between two groups (P<0.05). The appearance of transient damage recurrent laryngeal nerve was 3 cases (5.0%) and permannent damage was 3 cases in exposing nerve group and were 8 cases (20%) and 6 cases (15%) respectively in non-exposing nerve group. There was significant difference between two groups (P<0.05). Conclusion The application of exposing recurrent laryngeal nerve in high-risk thyroid surgery is highly minimally invasive with low hospitalization costs and can reduce the postoperative damage of calcemia and recurrent laryngeal nerve with clear clinical effect so that it is worthy of clinic promotion.