Pregnancy is a challenging period that places great physiological stress on both the mother and fetus in the best of times. However, if pregnancy is compounded by endocrine disorders, the potential risks for maternal and fetal adverse outcomes can be enormous. The thyroid is an important gland in our body that helps to regulate the chemical processes to maintain life, including growth and energy consumption. Thyroid physiology is considerably modified during normal pregnancy and these alterations continue throughout gestation, helping to cope with increased metabolic demands (including increase in free thyroxine, reduction in thyrotropin and iodide and doubling of thyroxine-bindingglobulin). Owing to this, the interpretation of endocrine changes can pose a challenge to the treating physician. Mismanaged hypothyroidism in pregnancy leads to poor maternal and fetal outcomes. The mother may be more likely to develop pre-eclampsia, preterm birth, still birth, mandatory CS, postpartum hemorrhage and gestational diabetes while the baby may develop neurosensory disabilities such as cerebral palsy, blindness, deafness and other developmental delays. This paper focuses on guidelines for managing thyroid dysfunction in pregnancy in order to improve outcomes for mothers and their babies. It explains the use of universal and targeted screening and subsequent drug based management and outcomes. It will elucidate interplaying factors behind potential benefits or harms for women and their babies. It will also explore remedial or intervention measures to tackle the problem with favorable impact on health and service costs; specially in developing countries.