Hypothyroidism is a condition with an underactive thyroid gland. Since thyroid hormones play a major role in metabolism, hypothyroidism is often associated with metabolic syndrome.Thus, the patient’s awareness regarding metabolic syndrome is crucial.Considering this background, we intended to develop a Pictogram-based Patient Information Leaflet (P-PIL) for hypothyroidism with metabolic syndrome to provide concise patient education. The developed leaflet was evaluated for its accuracy and reliability. This is a quasi-experimental study without a control group. The leaflet's FleschReading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores were 62.0 and 7.1 respectively. The Baker Able Leaflet Design (BALD) index of English, Kannada, and Malayalam versions of the P-PIL were 28, 27, and 27 respectively. The user testing of the P-PIL was assessed in 72 patients. The overall mean knowledge assessment scores showed a significant improvement from 52.92 ± 6.90 to 77.92 ± 9.31.The majority of the patients, specifically 84.72%, had an opinion that the design and layout of the P-PIL is good.The evaluation results strongly suggest that this P-PIL can be an effective educational tool for hypothyroidism patients with metabolic syndrome.