This study evaluated the effectiveness of an integrated preconception and antenatal management strategy in women with hypothyroidism and obesity. A prospective comparative study included 120 women divided into an intervention group receiving a structured management program and a comparison group receiving conventional care. The integrated approach comprised preconception counseling, optimization of levothyroxine therapy, nutritional support, weight-control measures, and regular thyroid function monitoring throughout pregnancy. Women managed according to the integrated protocol demonstrated better control of thyroid function, lower rates of gestational hypertension, preeclampsia, gestational diabetes mellitus, placental insufficiency, and preterm birth. Improved delivery outcomes and more favorable neonatal indicators were also observed. The findings support the effectiveness of comprehensive multidisciplinary management in reducing maternal and perinatal complications among women with hypothyroidism and obesity.