Background Thyroid dysfunction is associated with various cardiovascular manifestations including pulmonary hypertension, arrhythmias, cardiomyopathy, and ventricular dysfunction. Pulmonary hypertension is increasingly recognized in both hypothyroid and hyperthyroid patients and may contribute to unexplained dyspnea and cardiovascular morbidity. Early identification using two-dimensional echocardiography (2D Echo) may improve clinical outcomes. Aim To evaluate pulmonary hypertension in patients with thyroid disorders using two-dimensional echocardiography. Materials and Methods This hospital-based observational study was conducted in the Department of Pulmonology at Sree Mookambika Institute of Medical Sciences from October 2024 to April 2025. A total of 52 patients with hypothyroidism or hyperthyroidism were included using simple random sampling. Thyroid function tests were performed using enzyme immunoassay. Electrocardiography, chest X-ray, and 2D echocardiography were carried out in all patients. Pulmonary artery systolic pressure (PASP) was estimated using tricuspid regurgitation jet velocity by the modified Bernoulli equation. Patients with PASP >30 mmHg were considered to have pulmonary hypertension and were reassessed after treatment of thyroid dysfunction. Results Elevated PASP was observed in both hypothyroid and hyperthyroid patients, with a higher prevalence among hyperthyroid individuals. Mean PASP in hyperthyroidism was 30.62 mmHg,while hypothyroidism showed a mean PASP of 26.97 mmHg. Follow-up assessment demonstrated significant reduction in PASP after treatment and restoration of euthyroid status. Conclusion Pulmonary hypertension is an important cardiovascular manifestation of thyroid dysfunction and may be reversible with timely treatment. Two-dimensional echocardiography is a useful noninvasive tool for early detection and monitoring of pulmonary hypertension in thyroid disorder patients.

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