What is the treatment for swollen legs, feeling heavy and extreme fatigue?

Question

Hi doctor,

I have been suffering from extreme fatigue, and I have been feeling heavy, swollen legs. My ankles have a permanent band around them that looks like a socks mark. I cannot lose weight no matter what I do. I elevate my legs and wear compression socks. I have hypothyroidism and fibromyalgia. Please help.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I have reviewed your attached images (attachments removed to protect the patient's identity). Yes, there is a swollen bilateral lower limb. You mentioned hypothyroidism, and the TSH (thyroid stimulating hormone) level was 17.6 mIU/L in the last test done, and you are already taking Levothyroxine 225 mcg. Kindly answer the following questions.

1. Are you taking Levothyroxine tablets daily, or any variable adherence to the medication?

2. Are you taking other medications like proton pump inhibitors, calcium supplements, iron tablets, sucralfate, estrogen-containing medication, tablet with meals, etc.?

3. Any complaints of diarrhea episodes or any other malabsorption symptoms?

I am asking the above questions because your Levothyroxine dose requirement is more than 200 mcg. At this value, it is essential to rule out causes of increased T4 (thyroxine) requirement like any other medication interference, T4 absorption, malabsorption syndrome, or decreased adherence with medication. You should take guided help from a dietitian and weight reduction instructions to reduce overweight. Also, please get the latest thyroid profile test to readjust the Levothyroxine dose. The main cause is hypothyroidism, which needs to be addressed optimally.

I hope the information will help.

Thanks.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

It means there is no other factor responsible for the increased T4 (thyroxine) requirement. You should repeat the thyroid profile test as early as possible to adjust the dose of Levothyroxine. After the thyroid level gets under control, you would find symptomatic relief, and swollen lower limbs with peripheral edema would become mild. Through this chat consultation, I have the following to suggest to you:

• Maintain strict medication adherence.

• Repeat the thyroid profile test asap to adjust the dose of Levothyroxine.

• Also, get the hemoglobin and kidney function test done.

• Get a dietitian opinion regarding your diet.

• Weight reduction strategy to decrease weight.

• To prevent lower limb swelling, keep the foot level elevated while resting.

I hope this information will help.

Thanks.