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Background: Hypothyroidism is the most common hormonal deficiency worldwide; however, there is limited data about its prevalence in the children and adolescents of the Middle East. Methods: The prevalence of hypothyroidism were calculated by dividing the number of patients purchasing levothyroxine in 1397 Solar-Hijri year (Correlate with March 2018-February 2019) by the population at risk (per 10 000 persons). Data were collected from the Iran health insurance organization registration records and family physician databases of health vice-chancellor of Shiraz University of Medical Sciences. Results: The present study shows that the prevalence of levothyroxine treated population aged under 18 years is 13 in 10 000 in the Fars province and it is more common in females (17 in 10 000 in females versus 9 in 10 000 in males). This study also revealed that the prevalence of hypothyroidism was different in various age groups and increased in older children and adolescents after pubertal ages. Also, an increase in the female: male ratio of prevalence was more obvious during and after puberty. Conclusion: Our study showed that the prevalence of congenital hypothyroidism was 3/10 000 in southern Iran. Also, the prevalence of hypothyroidism in children and adolescents was totally 13/10 000 population, and this prevalence increased in older age and female gender. This prevalence was close to the data from iodine sufficient areas in Europe and the United States. [ABSTRACT FROM AUTHOR]