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Accordingly, a pragmatic preconception strategy is key for ensuring optimal thyroid disease outcomes in pregnancy. Preconception planning in women with hypothyroidism should pre\u2010empt and mirror the adaptive changes in the thyroid gland by careful levothyroxine dose adjustments to ensure adequate foetal thyroid hormone delivery in pregnancy. In hyperthyroidism, the goal of preconception therapy is to control hyperthyroidism while curtailing the unwanted side effects of foetal and maternal exposure to antithyroid drugs. Thus, pregnancy should be deferred until a stable euthyroid state is achieved, and definitive therapy with radioiodine or surgery should be considered in women with Graves\u2019 disease planning future pregnancy. Women with active disease who are imminently trying to conceive should be switched to propylthiouracil either preconception or at conception in order to minimize the risk of birth defects from carbimazole or methimazole exposure. Optimal strategies for women with borderline states of thyroid dysfunction namely subclinical hypothyroidism, isolated hypothyroxinaemia and thyroid autoimmunity remain uncertain due to the dearth of controlled interventional trials. Future trial designs should aspire to recruit and initiate therapy before conception or as early as possible in pregnancy.<\/jats:p>","DOI":"10.1111\/cen.13731","type":"journal-article","created":{"date-parts":[[2018,4,29]],"date-time":"2018-04-29T12:14:20Z","timestamp":1525004060000},"page":"269-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Preconception management of thyroid dysfunction"],"prefix":"10.1111","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2221-992X","authenticated-orcid":false,"given":"Onyebuchi E.","family":"Okosieme","sequence":"first","affiliation":[{"name":"Thyroid Research Group Systems Immunity Research Institute Cardiff University School of Medicine  Cardiff UK"},{"name":"Endocrine and Diabetes Department Prince\u00a0Charles Hospital Cwm Taf University Health Board  Merthyr Tydfil 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