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Foreword: Thyroid Dysfunction in Pregnancy.

Thyroid dysfunction is a common diagnosis during pregnancy, and one of the endocrinopathies known to result in both maternal and fetal morbidity. Diagnosis and treatment may sometime present a challenge to the obstetric provider. It is this knowledge that creates the impetus for this volume. Common symptoms of pregnancy, including fatigue, sleep disturbance, weight changes, skin and hair issues among others, may in fact be the warning signs of thyroid dysfunction and therefore something potentially more dangerous. The provider must be neither an alarmist or oblivious to the possibility that routine complaints may represent something more than meets the eye. A judicious index of suspicion is required. Compounding the problem is the physiology of pregnancy which may complicate the interpretation of commonly employed thyroid function tests. A working knowledge of these changes can aid the diagnostician in pursuing the proper workup. Poorly controlled thyroid dysfunction can have serious consequence and result in poor perinatal outcomes, including even death. Appropriate, and hopefully early, treatment will minimize these risks and usually improve outcomes. The options for treatment are not always straightforward, must be individualized, and monitored for efficacy. Ideally a multidisciplinary teamwould be involvedwithmost patients including possibly an obstetrician, primary care physician, endocrinologist, maternal fetal medicine subspecialist, neonatologist, critical care, and pediatric endocrinology as needed. A focus in this volume is too provide or suggest general treatment guidelines to aid providers in developing treatment plans. The authors of this volume have attempted to highlight areas where consensus exists, and also where controversy prevails. Controversy by itself is not always negative, but rather often is a result of incomplete or conflicting evidence. However, these can be situations that can be stressful for providers and patients when attempting to chart a management plan. Where such situations exist, we tried to highlight the different perspectives, the options available, opportunities for counseling and for new investigations. These include a clinical situations are often ideal for the shared decision making model. The authors of this volume are from