Aims Sex differences in the incidence of thyroid nodules (TNs) are broadly recognized, but further analysis is lacking. Thus, the aim of this study was to evaluate the association between TNs and anthropometric parameters in type 2 diabetic males and females. Materials and Methods This cross-sectional study included 747 patients with type 2 diabetes mellitus (T2DM). All patients underwent clinical examination, thyroid ultrasound, laboratory tests, anthropometrics and body composition. Multivariable logistic regression assessed factors associated with TNs, and a simple nomogram was finally developed. Results In total, the incidence of TNs was 36.95% (276/747) and was significantly higher in females (52.75%) than in males (27.85%). Age was positively correlated with TNs risk in patients with T2DM (males: OR = 4.141, 95% CI [1.999–8.577], females: OR = 4.630, 95% CI [1.845–11.618]). Obesity (OR = 2.655, 95% CI [1.257–5.607]) and hyperuricemia (OR = 1.997, 95% CI [1.030–3.873]) were only associated with the risk of TNs independent of other risk factors in type 2 diabetic females, as well as other obesity factors such as weight, BMI, waist-hip ratio, percent body fat, visceral curve area, and upper arm circumference, but not in type 2 diabetic males. However, the diameter of the largest thyroid nodule was only related to age (R = 0.226, p < 0.01). Finally, the nomogram for evaluating TNs in female T2DM patients was established, and the C-index of the nomogram was 0.704 (95% CI [0.89–0.94]). Conclusion TNs occur with a significantly higher frequency in type 2 diabetic females than in males, especially those with hyperuricemia and obesity. Modifiable metabolic factors, such as obesity and hyperuricemia, are a major focus for improving TNs risk in women.
