Background: Thyroid disorders represent the most prevalent endocrine dysfunctions in pregnancy, with significant implications for both maternal well-being and fetal development. Physiological adaptations of pregnancy often mask or mimic thyroid abnormalities, making early detection challenging yet crucial.

Objective: To critically evaluate the spectrum of thyroid dysfunction in pregnancy and its impact on obstetric and neonatal outcomes, while emphasizing evidence-based management strategies.

Methods: This abstract synthesizes current evidence from international guidelines and recent high-quality studies addressing overt and subclinical hypothyroidism, hyperthyroidism, and autoimmune thyroid disease in pregnancy.

Results: Overt hypothyroidism is strongly associated with increased risks of miscarriage, hypertensive disorders of pregnancy, anemia, placental abruption, and postpartum hemorrhage. Importantly, inadequate maternal thyroxine levels during early gestation are linked to impaired fetal neurodevelopment. Subclinical hypothyroidism, though often underrecognized, has also demonstrated associations with adverse perinatal outcomes. Conversely, uncontrolled hyperthyroidism poses serious risks including preterm birth, fetal growth restriction, low birth weight, and maternal cardiac complications, including thyroid storm. Autoimmune thyroid conditions further complicate the clinical course through transplacental passage of thyroid-stimulating or blocking antibodies, potentially leading to fetal and neonatal thyroid dysfunction.

Conclusion: Thyroid dysfunction in pregnancy demands a proactive, risk-based screening approach and meticulous management. Timely initiation of levothyroxine in hypothyroidism and judicious use of antithyroid medications in hyperthyroidism are pivotal in improving outcomes. A multidisciplinary, protocol-driven strategy is essential to minimize preventable complications and optimize both maternal and fetal health.

TBA