Hypothyroidism and obesity are common disorders among women of reproductive age and are associated with adverse pregnancy outcomes. This study evaluated thyroid function and maternal-fetal outcomes in 120 pregnant women, including 60 women with hypothyroidism and obesity and 60 healthy controls. Women with hypothyroidism and obesity had significantly higher TSH levels and a greater incidence of gestational complications, including preeclampsia, gestational diabetes, anemia, placental insufficiency, and preterm birth. Adverse neonatal outcomes, such as lower Apgar scores and increased neonatal hypoxia, were also observed. Early diagnosis, regular endocrine monitoring, and appropriate management may improve maternal and neonatal outcomes.