We present the case, clinical following and successful therapy of a patient undergoing maintenance hemodialysis that presents hyperthyroidism secondary to Jod Basedow phenomenon associated to multinodular goitre previous. This case is an unusual complication for subjects in regular hemodialysis (in the bibliography revised only three cases were described in the past years) and of difficulty therapeutic management being our limited experience. In our patient, the antiseptic application with iodo solutions in the arteriovenous fistula could be representing the main cause for the hyperthyroidism. Conventional carbimazole doses keep controlling the thyroid hyper-function. Afterwards the definitive treatment with radioiodine was a safe and effective method for a long-term control.