Data on the status of iodine deficiency in the Arabian peninsula is scarce. We have conducted a cross-sectional national epidemiological survey in Saudi Arabia to study the iodine status of Saudi schoolchildren, between eight and ten years, who were randomly selected, after taking into consideration the gender, provincial population and area distribution. Casual urine samples were collected and sent to the central laboratory for analysis. Clinical assessment for the presence of goiter was conducted in four areas with different geographical natures. The survey included 4638 subjects, and their median and mean (SD) of urinary iodine concentration was 18 and 17 m g/dL, respectively. We found provincial differences with respect to urinary iodine concentration and the percentage of subjects with urinary iodine concentration <10 m g/dL. The Southern province had the lowest median (11 m g/dL) and the highest percentage (45%) of subjects with urinary iodine concentration <10 m g/dL. On the other hand, subjects of the Western province had the highest median (24 m g/dL) and the lowest percentage (8%) of subjects with urinary iodine concentration <10 m g/dL. The clinical assessment revealed that the highest prevalence and more advanced grade of goiter (22%, 95% CI 19-25, grade 1; 8%, 95% CI 6-10, grade 2) was found in the Asir region, a high-altitude area in the Southern province. The lowest prevalence of goiter (4%, 95% CI 0.8-7.2, grade 1) was found in Gizan, an urban coastal community. There was a significant relationship between the prevalence of goiter and the urinary iodine concentration. The survey for iodine deficiency disorder (IDD) in Saudi Arabia has shown a mild degree of iodine deficiency in the Southern province. Odds ratio (OR) was used to study the statistical relationship between the prevalence of goiter and the urinary iodine concentration. There is a need to launch a control program to ensure the exclusive availability of iodized salt in Saudi Arabia, especially in the Southern province.