Abstract: Objective To analyze the relationship between thyroid hormone levels and abdominal aortic calcification in maintenance hemodialysis (MHD) patients, and to analysis the clinical indicators which related to vascular calcification, and to provide a clinical basis for early prevention and treatment of vascular calcification. Methods Data of a 78 MHD patients treated in the Hemodialysis Center of Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2019 were collected, and the dialysis age was ≥ 3 months. The clinical data and biochemical indicators of patients were collected, and free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured. Patients were examined for abdominal aortic calcification with plain lateral X-ray films, and the patients were divided into non-calcified group and calcified group according to whether vascular calcification occurred. The clinical data between the two groups were compared, and the relationship between thyroid hormone levels and abdominal aortic calcification in MHD patients was analyzed. Results Among 78 MHD patients, 36 had abdominal aortic calcification with an incidence of 46.15%. The calcification group had significantly higher low-density lipoprotein (LDL-C), blood phosphorus (P), C-reactive protein (CRP), and calcium-phosphorus products. In the non-calcified group, albumin and FT3 were significantly lower than those in the calcified group, and the differences were statistically significant (all P<0.05). Correlation analysis between FT3 and various indicators showed that FT3 was negatively correlated with CRP, LDL-C (all P<0.05). Multivariate logistic regression analysis of related risk factors showed that elevated CRP, elevated P, and decreased FT3 were independent risk factors of abdominal aortic calcification. The area under the ROC curve of CRP, P, FT3 were 0.804, 0.704 and 0.746 respectively. Conclusion The incidence of abdominal aortic calcification in MHD patients is high. The increase of CRP, P level and the decrease of FT3 level are closely related to abdominal aortic calcification. FT3 has certain value in predicting abdominal aortic calcification in patients with MHD.