Background: There are various changes in the thyroid gland and its function in chronic renal failure (CRF), these changes include lower levels of circulating thyroid hormone, altered peripheral hormone metabolism, decreased binding to carrier proteins, possible reduction in tissue hormone content, and increased iodine storage in the thyroid gland. The decrease of excretion of urinary iodine in CRF increases serum inorganic iodine level and iodine content of the thyroid, which consequently enlarges the gland.Aim of work: This study was designed to examine thyroid hormone concentration and thyroid morphology using ultrasonography among ESRD patients on hemodialysis.Patients and methods: Forty hemodialysis patient (20 males and 20 females) and twenty controls (10 males and 10 females) were included in this study. All the patients and controls were subjected to measurement of TSH, FT3 and FT4 along with thyroid ultrasonography.Results: FT3 (pg/ml) and FT4 (ng/dl) levels were significantly lower in hemodialysis patients (2.8 vs 3.37 and 0.8 vs 1.12, P value<0.05 respectively). Hypothyroidism prevalence was significantly higher in hemodialysis patients (20% vs 0%, P value <0.05). Thyroid lesion prevalence was higher in hemodialysis patients (27.5% vs 10%, P value>0.05). Thyroid volume (ml) was significantly larger in hemodialysis patients ( 9.6 vs 8.3, P value<0.05).Conclusion: Thyroid functional and morphological abnormalities are more common in hemodialysis patients than in general population so thyroid function test and thyroid ultrasonography should be considered in those patients.