Generalized edema on a hypothyroid patient with incorrect use of levothyroxine

Hypothyroidism is manifested when thyroid hormone isn’t enough for body's requirement and is usually diagnosed by high levels of TSH and low levels of fT4. Generalized edema is commonly associated with cardiovascular, hepatic, or renal diseases and is quite uncommon to see in hypothyroidism; the edema is usually generalized when the disease is severe. Generalized edema in hypothyroidism is traditionally accompanied with more serious hypothyroid symptoms, which is not the case here. It is discussed why the other common causes of generalized edema such as heart failure, advanced kidney disease, nephrotic syndrome, and cirrhosis do not fit here. And we emphasize the importance of thyroid hormone and drug use evaluation. In our case, a 60-year-old man comes with chief complaint of generalized swelling of his body and weakness that slowly worsening. He presents with extremely high blood pressure and generalized edema but with otherwise normal findings. From the labs there is high TSH and low ft4. He was then admitted and given supportive treatment. His levothyroxine was adjusted and he was reeducated for his wrong levothyroxine use, which he took after meal. He was then slowly improving and was discharged.