Background: After Sistan and Balouchestan, Golestan Province is ranked second in terms of TB prevalence in Iran. Therefore, a 5-year study was conducted to evaluate the alterations of TB epidemiologic indices in this Province. Materials and Methods: This was a trend study. All patients suffering from various forms of pulmonary tuberculosis (smear positive, smear negative, extrapulmonary and miliary) during 1999-2003 in Golestan Province were studied. Alterations of TB epidemiologic indices were evaluated by using Chi-square test.Results: Out of a total of 3,417 registered TB patients during 1999-2003 in the Center for Communicable Disease Control in Golestan, 2,773 (81%) were available and entered the study; 47% were male. 62.7% of patients had smear positive, 16.4% had smear negative, 20.7% had extrapulmonary and 0.1% had miliary tuberculosis. The overall incidence of all forms of TB during the study period was 36 in 100,000 and no significant difference was detected while assessing the alterations of this index during the study period. Incidence of TB had an increasing trend among children; its prevalence among 0-14 year old females was higher than males during the study period.Conclusion: Although Golestan Province is not adjacent to the Provinces with high TB prevalence, it is ranked second in terms of incidence and prevalence of TB and various factors such as immigration can affect TB epidemiologic indices. An independent study is required to evaluate the distribution of TB among different ethnic groups.