Abstract: Objective To determine the value of chest X-ray and cervical vascular ultrasound in predicting the presence of non-recurrent laryngeal nerves (NRLN) in patients with thyroid disorders. Methods Preoperative, intraoperative and postoperative documents of 2 251 patients with various thyroid disorders between January 2006 and December 2013 were reviewed. All of the patients underwent preoperative chest X-ray examinations. The patients who had confirmed NRLN during surgery were given a cervical vascular ultrasound examination postoperatively. Results A total of 49 patients (2.18%, A group) were identified having NRLN by preoperative chest X-ray as they showed aberrant right subclavian artery (ARSA). Of those suspected cases of NRLN, 23 (46.94%) were confirmed during subsequent surgeries and no NRLN injury was inflicted. In the 2 202 unsuspected cases (B group), 5 (0.23%) were discovered having NRLN during surgeries, and one (20.00%) NRLN injury occurred. ARSA were found in postoperative cervical vascular ultrasound examination in all of the 28 cases of NRLN confirmed during surgeries. The postoperative cervical vascular ultrasound suggested a normal right subclavian artery (RSA) for the 26 chest X-ray revealed but surgically dismissed cases of NRLN. The 23 X-ray predicted NRLN were revealed more quickly in surgeries than those that had been failed to show in X-ray (t=-18.867 2, P=0.000 0). Conclusion Chest X-ray of patients scheduled for thyroid surgery should be reviewed carefully and cervical vascular ultrasound should be allied for predicting ARSA before surgery. Detection of ARSA can accurately predict the existence of NRLN, preventing NRLN injury and shorten the duration of subsequent operations.