Hypothyroidism has been identified as an independent risk factor for the development of NAFLD, although the literature is inconsistent and the prevalence of NAFLD in hypothyroidism has not been well studied. Objectives: To study the prevalence of NAFLD in Hypothyroidism. To correlate hormonal, biochemical parameters and lipid indices in hypothyroidism with severity of NAFLD. Methodology: Observational, cross-sectional study amongst 100 adults with hypothyroidism aged between 18 to 60 years. Consecutive male and female hypothyroid patients attending the Endocrinology outpatient department were recruited after the inclusion and exclusion criteria were satisfied during the study period. All patients underwent thyroid and liver function testing and were evaluated for NAFLD using ultrasonography and Transient elastography. Results: The prevalence of NAFLD in hypothyroid patients is 38% (mild - 25 % and moderate - 13%). Waist circumference is significantly associated with the severity of NAFLD (p=0.006). Liver function tests - AST, ALT, and alkaline phosphatase are statistically associated with NAFLD severity (p=0.001). Subcutaneous abdominal adipose tissue (SAT) thickness is also statistically correlated with the NAFLD severity (p=0.05). Fibroscan results correlated significantly with the grades of NAFLD, which were based on USG criteria (p < 0.001). FIB-4 index also correlated significantly with the severity of hypothyroidism (p=0.016). There is a positive correlation between serum TSH level and grade of NAFLD, and it is found to be statistically significant (p<001). Conclusion: This study found a higher prevalence of NAFLD among adults with hypothyroidism. Higher TSH levels may be a risk factor for the increased incidence of NAFLD in hypothyroidism.