Adequate thyroid hormone in pregnancy is critical for normal fetal development. Thyroid disease is the most common endocrine problem in women of reproductive age. Hypothyroidism is estimated to occur in 4% of pregnancies and hyperthyroidism in 2.4% of pregnancies, majority of cases being subclinical thyroid dysfunction. While adverse effects of overt thyroid dysfunction in pregnancy on obstetric and offspring outcomes are well established, impact and need for treatment of subclinical thyroid dysfunction are more debated. Studies suggest increasing evidence of subclinical hypothyroidism leading to adverse pregnancy and offspring neurodevelopmental outcomes. However, no clear benefit of levothyroxine treatment of subclinical hypothyroidism in pregnancy is established in currently available clinical trials. Treatment of subclinical hypothyroidism in pregnancy needs to be individualized based on the degree and persistence of dysfunction and timing of diagnosis. On the other hand, there is no clear evidence of adverse impact of subclinical hyperthyroidism on pregnancy or offspring outcomes. Treatment of subclinical hyperthyroidism in pregnancy is not recommended. This review summarizes current evidence in assessment of thyroid function in pregnancy, evaluation and treatment considerations of subclinical thyroid dysfunction in pregnancy, and screening recommendation for thyroid dysfunction in pregnancy.

Normocalcemic primary hyperparathyroidism (NPHPT) is a phenotype of classic hypercalcemic primary hyperparathyroidism characterized by elevated parathyroid hormone (PTH) levels in the setting of persistently normal serum calcium. While increasingly recognized as a significant cause for endocrine referral, its pathophysiology remains poorly understood. The diagnosis of NPHPT is one of exclusion, necessitating the rigorous investigation and exclusion of all secondary causes of hyperparathyroidism. Predominantly identified in postmenopausal women during evaluation for osteoporosis or nephrolithiasis, affected patients often present with a greater burden of bone disease and renal complications than typical patients with hypercalcemic disease, likely a reflection of selection bias. The diagnosis and management of NPHPT are challenging in the setting of limited research and long-term outcome data. While parathyroidectomy has demonstrated improvements in bone density for appropriate surgical candidates, robust evidence regarding its impact on renal complications is lacking. This review synthesizes the current literature to inform clinical decision-making in the management of patients with NPHPT.