Pyrethroids are a class of widely-used insecticides that can be transported from terrestrial applications to aquatic systems via runoff and tend to sorb to organic carbon in sediments. Pyrethroid occurrence is detrimental to stream ecosystems due to toxicity to sediment-dwelling invertebrates which are particularly at risk of pyrethroid exposure in urban streams. In this work, 49 streams located in watersheds in the northeastern United States were surveyed for nine current-use pyrethroids using two extraction methods. Total sediment concentrations were determined by exhaustive chemical extraction, while bioaccessible concentrations were determined by single-point Tenax extraction. Total and bioaccessible pyrethroid concentrations were detected in 76% and 67% of the sites, and the average sum of pyrethroids was 232 ng/g organic carbon (OC) for total and 43.8 ng/g OC for bioaccessible pyrethroids. Bifenthrin was the most commonly detected pyrethroid in streambed sediments. Sediment toxicity was assessed using 10-d Hyalella azteca bioassays, and 28% and 15% of sediments caused a decrease in H. azteca biomass and survival, respectively. A temperature-based focused toxicity identification evaluation was used to assess pyrethroids as the causal factor for toxicity. The concentrations of pyrethroids was only weakly correlated with the degree of urban land use. Sediment toxicity was predicted by total and bioaccessible pyrethroid concentrations expressed as toxic units. This work suggests that bioaccessibility-based methods, such as Tenax extraction, can be a valuable tool in assessing sediment toxicity.