Thyroid dysfunction in pregnancy: optimizing fetal and maternal outcomes.

Recent decades have seen a growing awareness of the threat posed by thyroid dysfunction in pregnancy on maternal, fetal and neonatal well-being. Uncontrolled hypothyroidism and hyperthyroidism are associated with adverse obstetrics and fetal outcomes and also affect neurointellectual development in the offspring. Excellent outcomes are, however, achievable with appropriate management. An understanding of the changes in thyroid hormone economy in pregnancy is crucial to the evaluation of thyroid status in pregnant patients with thyroid dysfunction. Furthermore, a balance must be maintained between the control of maternal disease and the requirements of the developing fetus. Careful monitoring of patients in a multidisciplinary care setting, and appropriate adjustments of treatment, is essential throughout pregnancy and the puerperium. In this special report we summarize best practice in the management of thyroid dysfunction in pregnancy.