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Objective To compare the efficacy of levothyroxine treatment (LT) in early and mid-term pregnancy for pregnant women with subclinical hypothyroidism. Methods A total of 100 cases of subclinical hypothyroidism in pregnant women were observed at the Department of Obstetrics and Gynecology of the Affiliated Hospital of Xiangnan University from January 2020 to October 2022. The subjects were divided into early pregnancy LT group and mid-term pregnancy LT group at a ratio of 1:1, with 50 cases in each group. The early pregnancy LT group received LT intervention on the second day of subclinical hypothyroidism diagnosis (8-10 weeks). The mid term pregnancy LT group received LT intervention during mid pregnancy (13-16 weeks) follow up. The levels of TSH, FT4, and FT3 in fasting blood samples were determined by chemiluminescent immunoassay. Pregnancy complications and outcomes were compared between the two groups. Results The duration of pregnancy at registration was (57.88±12.20) days in the early pregnancy LT group and (58.78±10.08) days in the mid term pregnancy LT group. Compared with before treatment, the serum TSH levels significantly decreased in both groups after LT treatment (before delivery) (P<0.05), with no statistically significant difference between the two groups (P>0.05). Additionally, there were no significant differences in serum FT3 and FT4 levels before and after treatment, as well as between the two groups (P>0.05). Compared with the early pregnancy LT group, the mid-term pregnancy LT group showed a significant increase in the risks of miscarriage, pregnancy-induced hypertension, and neonatal admission to the NICU (P<0.05). After controlling for the impact of TPOAB positivity, miscarriage, pregnancy induced hypertension, and neonatal admission to the NICU were closely related to the mid term pregnancy LT group (P<0.05). Conclusion The timing of initiating LT treatment for subclinical hypothyroidism may influence the prevention of adverse pregnancy outcomes. Early pregnancy LT intervention may help reduce the occur-rence of miscarriage, pregnancy induced hypertension, and neonatal admission to the NICU. [ABSTRACT FROM AUTHOR]