Background <p>Incidental parathyroidectomy (IP) is an important complication of thyroidectomy, and its risk may differ between malignant and benign thyroid pathology. This study aimed to evaluate the association between malignant thyroid pathology and the risk of IP in patients undergoing thyroidectomy.</p> Methods <p>A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Scopus, PubMed/MEDLINE, Web of Science, Embase, and Google Scholar were searched from database inception to November 15, 2025. Eligible studies included cross-sectional, cohort, or case-control studies that compared the incidence of IP between patients with malignant and benign thyroid pathology after thyroidectomy. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Sensitivity analysis and assessment of publication bias were also performed.</p> Results <p>Thirty-three studies comprising 8,062 patients with IP and 25,134 controls without IP were included. Malignant thyroid pathology was associated with significantly higher odds of IP than benign thyroid pathology (OR 1.58, 95% CI 1.30–1.92). In subgroup analyses, no statistically significant associations were observed for Hashimoto’s thyroiditis (OR 1.29, 95% CI 0.95–1.74), papillary thyroid carcinoma (OR 1.29, 95% CI 0.90–1.83), or follicular carcinoma (OR 0.70, 95% CI 0.41–1.19). Sensitivity analysis showed that the overall findings were robust, and Egger’s test did not indicate significant publication bias.</p> Conclusion <p>Malignant thyroid pathology was modestly associated with IP; however, substantial heterogeneity, residual confounding, and reliance on crude observational data suggest malignancy may primarily reflect operative complexity rather than an independent causal risk factor. Findings should therefore be interpreted as exploratory associative evidence.</p>