Introduction: The thyroid hormone is essential for growth and development in children. Acquired hypothyroidism is sporadic in occurrence and commonly occurs due to autoimmune Hashimoto__ampersandsignrsquo;s thyroiditis. Fluoride can interfere with the normal functioning of the thyroid gland by competing with iodine for uptake and lead to delayed development, degeneration as well as impairment of brain function. Objective: The study aimed to assess fluoride levels in drinking water and their association with acquired hypothyroidism. Methods: A prospective observational study was conducted in which children were screened for symptoms of acquired hypothy roidism and underwent thyroid function tests. The children with elevated thyroid-stimulating hormone (TSH) levels were included in the study and the fluoride content of drinking water was measured. Results: Out of 153 children who underwent thyroid profile, 45 children were diagnosed with acquired hypothyroidism based on elevated TSH level. The commonest clinical presentation in the study population was fatigue (57%), dry hair (42 %) and consti pation (31%). The mean TSH level was 31.21(mIu/L) and the mean fluoride content in drinking water was 0.462, the minimum and the maximum level were 0. 10 mg/l and 1. 20 mg/l respectively. Conclusion: In our study, the majority of children (58 %) were consuming pipeline water from panchayat or municipal source. The mean fluoride content in drinking water of children with acquired hypothyroidism was normal (0.462 ppm) and only 3 children consumed water with high fluoride content (__ampersandsigngt; 1ppm). Children with low FT3 and low FT4 had normal fluoride levels in drinking water. There was no statistically significant correlation between FT3 ((R=0.23: P=0. 12) and FT4 ((R=0.21: P=0. 17) levels with fluoride levels in the drinking water. More studies with a large sample size have to be conducted to assess for any positive cor relation between high fluoride and thyroid dysfunction.