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Hypothyroidism is one of the most common endocrine complications in thalassemic patients, usually appearing in the second decade of life related to iron overload. Ultrasonography is one of the techniques most frequently used to evaluate the volume and structure of the gland. The aim of the present work was to evaluate the possible correlation between thyroid function and its appearance on ultrasound in 45 thalassemic patients. We found reduced antero-posterior diameter of the thyroid in 12 patients (26.6%), reduced echogenicity of the glandular tissue in 24 patients (46.6%), and diffuse spotty echogenicity in 15 patients (33.3%). In our opinion, these patterns may be useful to indicate the need for further diagnostic evaluation of thyroid function. Follow-up studies are necessary to confirm this hypothesis.