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Pulmonary hypertension is high blood pressure within the artery that connects the lungs and heart. It forces the heart to work harder to transfer blood between the heart and lungs, which may lead to an enlargement of the right side. Thyroid problems, whether they involve an underactive or overactive thyroid, can cause a heart to enlarge.
A bilateral atrial enlargement can be caused by some conditions that usually cause your heart to pump harder than usual or they also can damage your heart muscle. In some cases the heart enlarges and becomes very weak, but that is usually for some unknown reasons. Also, very high blood pressure can cause this.