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Background: Excess iodine from iodinated contrast media (ICM) can lead to thyroid dysfunction. Children, especially neonates and premature infants, may be more vulnerable due to their immature thyroid physiology. Methods: A systematic review was conducted using EMBASE, MEDLINE (PubMed), Cochrane, Web of Science, and Scopus. Inclusion criteria were studies in children ≤ 18 years receiving ICM and that reported effects on thyroid function. Exclusion criteria included topical iodine exposure, prenatal administration, and irrelevant endpoints. Case reports, reviews, and abstracts were also excluded. Results: Most studies reported temporary thyroid function disturbances following ICM exposure in children, particularly subclinical hypothyroidism. Overt hypothyroidism was rare and occurred mainly in neonates and high-risk groups. In certain studies, up to 25% of neonates showed TSH abnormalities, with a subset requiring levothyroxine treatment. Although even more rare, some studies also reported cases of thyrotoxicosis after ICM exposure. Conclusion: ICM exposure can lead to thyroid dysfunction in children, especially in neonates, preterm infants, and those with risk factors. Risk-based screening and monitoring are recommended to allow timely detection and treatment.