Dear Dr. Joshua:
Over the last six months or so I have been experiencing quite a bit of swelling in both of my legs, from the knee up, and in both of my arms, from the elbow up. At first it was just uncomfortable but now, in the last month to two months, it has gotten worse. My legs and arms stay pretty swollen all day and now I’m experiencing pain that shoots up my legs, from the knee up, and I find that when I stand on my feet a lot they get really bad, but at the same time getting off my feet doesn’t give me instant relief, as a matter of fact my legs hurt when I’m sitting as well. My legs have become swollen to the point that my slacks don’t fit, I have gone up a size to compensate. At first I thought I was just retaining water but after having taken a diuretic it didn’t change. I also find that my feet and hands are colder than the rest of body (if you touch them you can actually fell how cold they are). I take .2mg of synthyroid and phentermine 37.5mg and I just turned 50 a week ago. Is this anything I should be concerned about or is it just water retention?
Dr. Joshua’s Answer:
Swelling of the extremities can be a symptom of water retention, heart failure, kidney failure, salt imbalance, deep venous thrombosis, disorders of lymphatic circulation, etc…so you see there are quite a few possible causes and it’s impossible for me to say what’s causing this. However, your symptoms are not typical of water retention - usually the swelling would appear from the knee down and from the elbows outward, i.e. distal. The fact that you are experiencing swelling in the proximal part of your extremities may suggest something else. One possibility is the buildup in fatty tissue. This could be due to just simply gaining weight due to your diet and exercise regimen not holding up, or could be a sign of a corticosteroid hormone imbalance, e.g. Cushing’s syndrome. Also, other hormones such as thyroid hormone regulates weight and fat balance. When was the last time your thyroid lab test was done?
What you need is a clinical examination: Thorough history and a physical examination, and possibly some basic lab tests such as TSH. Your primary care physician should be able to figure out what’s going on.
Good luck!
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