OBJECTIVES: To evaluate whether hypothyroidism is a risk factor for transient ischemic attack (TIA). METHODS: We systematically searched Embase, PubMed, Cochrane, Vipers database, China Biomedical Literature Database, Wanfang Data, and China National Knowledge Infrastructure for studies assessing the association between hypothyroidism and TIA (publication cut-off in May 2024). Two researchers independently extracted the data based on inclusion and exclusion criteria. Meta-analysis was carried out using Review Manager 5.3 software. RESULTS: A total of 7 studies (combined n=190248) were included. Hypothyroidism showed a significant association with TIA (risk ratio [RR]=1.43 [95% confidence interval [CI]: [1.29-1.57]). The association was significant in clinical hypothyroidism (RR=1.45 [95% CI: [1.31-1.62]) but not evident in subclinical hypothyroidism (RR=1.20 [95% CI: [0.90-1.61]). Sensitivity analysis confirmed the stability and reliability of the results from the 7 studies (Begg's test z=1.2, CONCLUSION: Hypothyroidism, particularly clinical hypothyroidism, may be an independent risk factor for TIA.