BackgroundEvidence regarding adverse pregnancy outcomes in patients with thyroid cancer has been conflicting, and the effect of thyroid dysfunction caused by thyroid hormone suppression therapy in terms of neonatal thyroid stimulating hormone (TSH) is unclear. This study aimed to investigate whether thyroid cancer was associated with adverse pregnancy outcomes and had an adverse effect on neonatal thyroid function.MethodsThis was a retrospective study of 212 singleton pregnancies with thyroid cancer and 35,641 controls without thyroid cancer. Data on maternal pregnancy outcomes and neonatal outcomes were analyzed.ResultsThe median TSH level in the thyroid cancer group was significantly lower than that in the control group (0.87 µIU/mL vs. 1.17 µIU/mL;P< 0.001), while the FT4 level was higher than that in the control group (17.16 pmol/L vs. 16.33 pmol/L;P< 0.001). The percentage of thyroid peroxidase antibodies (TPOAb) positive in the thyroid cancer group was significantly higher than that in the control group (25.0% vs. 11.8%;P< 0.001). Pregnancies with thyroid cancer had a higher risk of late miscarriage (OR 7.166, 95% CI: 1.521, 33.775,P= 0.013), after adjusting maternal TPOAb positive, there was no statistical significance (OR 3.480, 95% CI: 0.423, 28.614,P= 0.246). Pregnancies with thyroid cancer had higher gestational weight gain (GWG) (14.0 kg vs. 13.0 kg,P< 0.001). Although there was no significant difference in the prevalence of gestational diabetes mellitus (GDM) (20.8% vs. 17.4%,P =0.194), the oral glucose tolerance test (OGTT) showed that fasting plasma glucose and 2-hour value in the thyroid cancer group were higher than those in the control group (P= 0.020 and 0.004, respectively). There was no statistically significant difference in TSH between the thyroid cancer group and the control group, regardless of full-term newborns or preterm newborns.ConclusionsThyroid cancer might not have substantial adverse effects on pregnancy outcomes except for excessive GWG. No adverse effect on neonatal TSH was found, but the effect on long-term thyroid function and neuropsychological function in offspring need further study.Trial registrationBeijing Birth Cohort Study (ChiCTR220058395).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-023-05588-4.