Hypothyroidism in the rat is associated with a decrease in kidney size and weight. We have shown previously that this decrease involves all nephron segments in the cortex and outer medulla and is especially pronounced in the medullary thick ascending limb (mTAL). Therefore, the present study was undertaken for examination of the effect of hypothyroidism on the ultrastructure of the rat mTAL. Hypothyroidism was induced by feeding aminotriazole (ATZ), 0.5 g/kg of food, for 4 weeks. A second group of animals received ATZ plus a daily injection of L-thyroxine (T4). A third group was fed a normal diet only and served as control animals. The kidneys were preserved by in vivo perfusion with 3% glutaraldehyde, and tissue from the inner and outer stripe of the outer medulla was processed for electron microscopy. Morphometric analysis revealed a significant decrease in the cross-sectional area of the mTAL in both the inner and outer stripe of the outer medulla in hypothyroid animals. No changes were observed in the surface density of either the apical or basolateral plasma membranes following ATZ treatment. However, when calculated per millimeter tubule, there was a significant decrease in the surface area (SL) of both the apical and basolateral plasma membranes of the mTAL of hypothyroid animals in comparison with control animals. Simultaneous treatment with T4 prevented the ATZ-induced reduction in both tubule cross-sectional area and in the SL of the plasma membrane. These findings suggest that the observed changes in SL of the plasma membrane of the mTAL are due to a regulatory role of thyroid hormone in membrane proliferation as well as in cell growth in general.