Background: In most cases, hypothyroidism is not linked to kidney disease. However, hypothyroidism has been shown to hasten the development of chronic kidney disease (CKD).Objective: The aim of the current study is to evaluate thyroid abnormalities in patients with end stage renal disease (ESRD) in a sample of Egyptian populations. Patients and methods: A case control study was conducted on 70 Egyptian patients selected from the Nephrology Department in Theodor Bilharz Research Institute. Participants were divided into 2 groups; Group 1 included 40 patients with ESRD, with eGFR <15 mL/min, with no history of thyroid disease or receiving any thyroid medications. Group 2 included 30 health subjects, age and sex matched, with normal renal function, with no history of thyroid disease or receiving any thyroid medications. All subjects underwent full thyroid profile, and estimated GFR. Results: Symptoms of thyroid dysfunction were more frequent in ESRD group; statistically significant only in muscle weakness. TSH was statistically significantly higher in Group 1 cases with hypothyroidism. Thyroglobulin autoantibodies (TgAbs) were statistically significantly higher in cases with hypothyroidism. Antimicrosomal antibodies recorded only in hypothyroid cases. Free T3, TSH, TgAbs and thyroid volume had perfect diagnostic performance in diagnosing hypothyroidism among ESRD group < strong>. Conclusion: Frequency of hypothyroidism was higher in ESRD patients compared to the control group. Thus, it is important to keep monitoring thyroid functions in patients with advanced renal impairment that may enhance quality of life.