Thodupuzha features highly undulating terrain. The western edges of the town are relatively flat, aligning with the coastal plains of central Kerala, while the eastern fringes are marked by steep hills, valleys, and rocky outcrops.
The town's lowest points lie along the flood plains of the Thodupuzha River, while the highest elevations are found on the eastern hillocks that foreshadow the Western Ghats. The region does not have true mountains within its municipal limits, but it is heavily defined by small, steep hills (often terraced for agriculture) and lush river valleys.