Background: Metabolic syndrome (MetS) is well distinguished by insulin resistance, obesity, dyslipidemia, as well as hypertension, it has been increasingly associated with thyroid dysfunction. Thyroid nodules in addition to enlarged thyroid volume are commonly seen in MetS patients, though link remains unclear, especially in iodine-deficient areas like Egypt. The purpose of this work was evaluation of possible relationship between components of MetS changes in thyroid morphology, particularly thyroid volume nodularity, to explore possible metabolic contributors to these changes. Methods: We carried out this case–control study on 64 individuals at Zagazig University Hospital, comprising 32 MetS patients, 32 individuals who were age- and sex-matched as healthy controls. All individuals underwent comprehensive assessments including anthropometric measurements, thyroid function tests, metabolic profiling, and thyroid ultrasonography. Anti-thyroid antibodies were also measured. Results: Compared to controls, MetS patients had significantly higher BMI, waist circumference, TSH (mean 2.7 vs. 1.9 mIU/L, p = 0.0004), and thyroid volume (mean 17.8 vs. 12.9 mL, p < 0.001). Thyroid nodules were found in 68.75% of MetS patients versus none among the controls (p < 0.001). Among MetS cases, those with enlarged thyroids had significantly higher insulin resistance (HOMA-IR: 3.7 vs. 2.8, p = 0.006) and fasting insulin levels (p = 0.02). Anti-TPO as well as anti-thyroglobulin antibodies were also significantly elevated in those with both enlarged thyroids and nodules. incidence of thyroid nodules, potentially driven by insulin resistance and autoimmune activity. These findings highlight importance of thyroid evaluation in MetS patients for early detection and management of thyroid abnormalities.