Background The occurrence of thyroid carcinoma in patients with Graves’ disease (GD) has been rising recently. However, the linkage between lipids and the incidence of thyroid carcinoma among GD patients is still not well-established. Objective The research aims to explore the relationship between serum lipid concentrations and the occurrence of thyroid cancer in patients diagnosed with GD. Methods We conducted a retrospective analysis of data from 512 patients with GD who underwent surgical procedures at our institution between 2015 and 2024. Our study focused on examining the correlations between various patient characteristics and the occurrence of thyroid cancer. Logistic regression models were developed to analyze the predictive factors. Ultimately, we constructed a predictive nomogram to estimate the potential of thyroid cancer in GD patients. Results Among the 512 patients with GD, 299 patients were pathologically confirmed as differentiated thyroid carcinoma (DTC) (58.4%). Multivariate analysis revealed that high triglyceride (TAG > 1.185 mmol/L), low high-density lipoprotein (HDL < 1.325 mmol/L), and overweight (body mass index (BMI) ≥ 25) were risk factors for malignancy. In addition, ultrasound characteristics, including nodules in the thyroid, aspect ratio imbalance, hypoechogenicity, irregular borders, and microcalcifications, were risk factors for malignancy. The predictive nomogram demonstrated significant clinical utility, exhibiting an area under the curve (AUC) of 0.91 (95% CI [0.88–0.94]) and 0.91 (95% CI [0.87–0.96]) in the training set and validation set. Moreover, a high level of TAG was a risk factor for central lymph node metastasis and high AJCC staging in GD patients with thyroid carcinoma. Conclusions Our study presents initial findings suggesting that elevated TAG levels, reduced HDL cholesterol levels, and overweight status are individually linked to the incidence of thyroid carcinoma in patients with GD. These results indicate that preoperative serum lipid profiles and BMI can serve as valuable predictors for the occurrence of thyroid carcinoma in this patient population.