Introduction: Graves’ disease is a common thyroid disorder in the Philippines, affecting 8.53% of adults, with 0.61% experiencing overt hyperthyroidism. Although cardiovascular complications such as tachycardia and atrial fibrillation are well-known, pericardial involvement—particularly effusive–constrictive pericarditis (ECP)—is exceedingly rare, with fewer than five cases reported globally during thyroid storm. This case is the first Philippine report of thyroid storm-induced ECP, illustrating a unique cardio-endocrine interplay.

Case: A 29-year-old Filipino woman with poorly controlled Graves’ disease presented in thyroid storm, complicated by chest pain and respiratory distress. Initial echocardiography revealed a large pericardial effusion causing tamponade. Emergent pericardiostomy was performed. Serial echocardiography demonstrated evolving constrictive pericarditis, evidenced by septal bounce, annulus reversus, and expiratory hepatic vein diastolic flow reversal. These findings guided intensified medical management, resulting in rapid clinical and hemodynamic improvement without surgical intervention.

Discussion: This case highlights how thyroid hormone excess can trigger autoimmune pericardial inflammation, leading to this rare ECP variant. Echocardiography was pivotal—not only confirming tamponade but detecting dynamic progression to constriction. This real-time imaging enabled timely adjustments in therapy, preventing unnecessary surgery and promoting recovery. The case underscores echocardiography’s evolving role as a critical, dynamic tool in managing complex cardio-endocrine syndromes.

Conclusion: Thyroid storm complicated by pericardial disease demands heightened echocardiographic vigilance. In TB-endemic regions like the Philippines, where infectious causes predominate, clinicians must also consider autoimmune pericarditis. Serial echocardiography is essential to recognize evolving ECP, guide treatment, and improve outcomes. This case exemplifies the power of interdisciplinary collaboration and advanced imaging in transforming a rare, life-threatening paradox into a full recovery—offering a valuable learning experience for clinicians facing atypical thyroid storm presentations.

Rose Jean G. Cue is a 38-year-old female and a 3rd-year cardiology fellow at Perpetual Help Medical Center, Las Piñas. She has a strong passion for clinical research, particularly in cardiology, with a keen interest in identifying unique patient cases and contributing to medical knowledge through detailed case reports. Throughout her fellowship, she has actively engaged in both academic and clinical research projects, focusing on improving patient outcomes and advancing cardiology practice. Rose Jean is dedicated to continuous learning and collaboration, aiming to bridge the gap between clinical practice and research. Her goal is to publish insightful case reports and original research that can aid fellow clinicians and enhance patient care. She is committed to upholding high standards of scientific inquiry and ethical practice in all her endeavors.