Creating high-quality scientific figures can be time-consuming and challenging, even though sketching ideas on paper is relatively easy. Furthermore, recreating existing figures that are not stored in formats preserving semantic information is equally complex. To tackle this problem, we introduce DeTikZify, a novel multimodal language model that automatically synthesizes scientific figures as semantics-preserving TikZ graphics programs based on sketches and existing figures. To achieve this, we create three new datasets: DaTikZv2, the largest TikZ dataset to date, containing over 360k human-created TikZ graphics; SketchFig, a dataset that pairs hand-drawn sketches with their corresponding scientific figures; and SciCap++, a collection of diverse scientific figures and associated metadata. We train DeTikZify on SciCap++ and DaTikZv2, along with synthetically generated sketches learned from SketchFig. We also introduce an MCTS-based inference algorithm that enables DeTikZify to iteratively refine its outputs without the need for additional training. Through both automatic and human evaluation, we demonstrate that DeTikZify outperforms commercial Claude 3 and GPT-4V in synthesizing TikZ programs, with the MCTS algorithm effectively boosting its performance. We make our code, models, and datasets publicly available.