Objective To investigate the correlation of Helicobacter pylori (Hp) infection with lipid metabolism disorder and thyroid nodules in the elderly people on physical examination. Methods A cross-sectional study was conducted on 371 elderly population who underwent physical examination in the Affiliated Hospital of Jiangnan University from March 2021 to August 2023. Hp infection, lipid metabolism and thyroid nodules were examined after enrollment. According to Hp infection, the patients were divided into the positive group and the negative group. The blood lipids levels and thyroid examination results were compared between the two groups. Pearson analysis was used to investigate the correlation of Hp infection with lipid metabolism and thyroid nodules. SPSS 25.0 was used for statistical analysis. Data comparison between two groups was performed using t test, one-way analysis of variance, or χ² test depending on data type. Results Among 371 subjects on physical examination, 213 (57.41%) were positive for Hp infection. The levels of total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) in the positive group were significantly increased, and the level of high-density lipoprotein cholesterol (HDL-C) was significantly decreased; the incidence rates of hyper-TC-emia, hyper-TG-emia, hyper-LDL-C-emia and hypo-HDL-C-emia in the positive group were significantly higher than those in the negative group (P<0.05), and the differences were statistically significant (P<0.05). The detection rate of thyroid nodules was significantly higher in the positive group than that in the negative group (P<0.05), and there was no statistically significant difference in the thyroid imaging reporting and data system gradings between the two groups. The ¹⁴C value of Hp-infected people was positively correlated with the levels of TC, TG and LDL-C (r=0.398,0.471,0.503; P<0.05), and was negatively correlated with HDL-C (r=-0.426; P<0.05). Conclusion Hp infection in the elderly population on physical examination is related to lipid metabolism disorders and thyroid nodules, and there is a close relationship between the levels of blood lipids.