Background: Overt hypothyroidism is characterized by decreased free thyroxine T4 serum levels or elevated thyroid-stimulating hormone. It is reported in 0.3 to 0.5% in pregnancy. This study aimed to describe the presentation of pre-eclampsia like syndrome among pregnant women with overt hypothyroidism, provide a management strategy for pre-eclampsia like syndrome among pregnant women with overt hypothyroidism and report the incidence of associated complications with overt hypothyroidism in pregnant women. Methods: This was a cross sectional study conducted on 50 patients with preeclampsia associated with severe hypothyroidism. All studied cases were subjected to Physical examination, thyroid examination, routine laboratory investigations and fetal ultrasounds. Results: Low APGAR score (