Background: Hypothyroidism in patients with metabolic syndrome is associated with worse outcomes. However, this has not yet been adequately investigated in Bangladeshi people. Objective: To find out the proportion and covariates of hypothyroidism among patients with metabolic syndrome. Materials and methods: A hospital-based cross-sectional study was conducted with 323 patients from the Endocrinology and Allied Medicine Department at BIRDEM General Hospital. Patients with metabolic syndrome but no prior diagnosis of hypothyroidism were included. Detailed history, physical examinations, and thyroid function tests—Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), and Anti-Thyroid Peroxidase Antibody (Anti-TPO Ab)—were performed. Subclinical hypothyroidism was defined as TSH >4.12 mIU/L and <10 mIU/L, while overt hypothyroidism was defined as TSH >10 mIU/L. Statistical analyses, including Chi-square tests, ANOVA, Pearson's correlation, and multiple linear regression, were conducted to explore associations between components of metabolic syndrome and thyroid dysfunction. Results: Out of the 323 participants, 62.8% were euthyroid, 28.5% had subclinical hypothyroidism, and 8.7% had overt hypothyroidism. Autoimmune hypothyroidism was confirmed in 31.6% of hypothyroid patients through elevated Anti-TPO Ab levels, a statistically significant finding. Hypothyroidism was significantly more prevalent in females and obese individuals. Significant positive correlations were observed between TSH and waist circumference (r=0.153), systolic blood pressure (r=0.271), and triglycerides (r=0.128), while FT4 showed negative correlations. Multiple linear regression indicated significant associations between waist circumference, fasting plasma glucose, and thyroid dysfunction. Conclusion: It was concluded that a higher proportion of metabolic syndrome cases were suffering from hypothyroidism. This necessitates that all MetS patients be screened for thyroid profile and autoimmune status and managed accordingly.