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Suffering from hypothyroidism, diabetes, osteoarthritis. Have swollen ankle. Proper diagnosis?

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General & Family Physician
Practicing since : 2012
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My mother is 54 years old. She has hypothyroidism, diabetes, osteoarthritis on hip joints.From 16 March, she has swollen ankle and it has worsened today, even after administering strong oral antibiotics (Augmentin 625), 5 times now. What could be the reason and what shall we do further?
As per my mom's story, she had some mosquito bite because of which itching developed and she scratched that portion. That place got reddish.This started spreading on her hands too. Doctor prescribed anti-inflammatory, antibiotics, for allergy and diabetes. Doctor said it could be cellulitis. Could it lead to swelling that too for 5 days and especially swelling increasing on 5th day.
Am much worried. Please describe her case in detail and steps/precautions going forward.
Posted Thu, 11 Apr 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Achuo Ascensius 2 hours later

Thanks for the query.

From what you have said, your mother is presenting with a swollen ankle and not both ankles? Well if that is the case, the possible causes will be more of a localized cause rather than from the body's system.

It is important to rule out trauma, if she had any trauma or a simple torsion of the leg or missed her step which initially did not even pain very much, then it could probably from the trauma.
Osteoarthritis of the ankle and as well as septic arthritis of the ankle is possible but rare. Augmentin is an antibiotic and will help only in septic arthritis. What she needs is some ant-inflammatory to reduce pains and swelling if cause is inflammatory (pains during the day and night and does not calm on rest).

Another possible cause could be a gouty attack, however this would be less likely as the most common site is on the big toe.

It will be necessary to get the leg examined by a doctor and to do an x-ray of the affected ankle to rule out trauma and to do a uric acid level to rule out a gouty attack.

Concerning the mosquito bites, the symptoms you have describe are classical and could even progress beyond in severe cases. What she needs is anti histaminic drugs to stop continuous secretion of histamine that promotes the reaction and itch. Cellulitis is an infection of the skin and is a possible complication of the bite and in this case antibiotics will be needed and anti-inflammatory not.

Hope I have answered your query. If you do have any other query, I shall be ready to help.

Best regards and hope this helps.
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Follow-up: Suffering from hypothyroidism, diabetes, osteoarthritis. Have swollen ankle. Proper diagnosis? 5 hours later
She didnt slip any step and hence is not trauma, as I confirmed with her. Also, the swelling is both the ankles especially.. what could it be?

As I said, after having antibiotics (Augmentin) 5 times her swelling (on both the ankles) increased yesterday. What could be the zeroed in possibility?

Which specialist to get her to, for examining her legs?
Answered by Dr. Achuo Ascensius 3 hours later
Thanks once more for the query.
The information you have just given that it’s not trauma and that it is on both ankles is very relevant and supports the fact that the cause is more systemic than localized as we previously thought for a one ankle affection.
What she is presenting with is called pedal edema which could be pitting (a pit is created when a finger is used to depress the swelling and it returns slowly) or non-pitting. Possible causes of pitting edema are a heart that is insufficient or kidneys that have altered function or a liver abnormality or malnutrition. With the history of diabetes and high cholesterol levels, heart insufficiency or altered kidney function are more likely to be the cause. Non pitting edema could be caused by poor lymph drainage.
You need to get her examined by an internist and for tests to be done including Heart ultrasound to check for the functioning of the heart and blood urea nitrogen and creatinine to evaluate kidney function.

Hope this helps you and if you have further clarifications to be made I will be ready to help. If you however do not have any further clarifications, you could close the discussion and rate the answer.
Best regards
Above answer was peer-reviewed by
Follow-up: Suffering from hypothyroidism, diabetes, osteoarthritis. Have swollen ankle. Proper diagnosis? 30 minutes later
What further if it is non-pitting?
Answered by Dr. Achuo Ascensius 7 hours later

Thanks once more for the query.

The most common cause of non pitting edema is a lymphatic disease which could be due to lymphatic insufficiency or due to an inflammation ( lymphangitis ).
Non pitting edema also occurs frequently in patients with rather hyperthyroidism unlike those with hypothyroidism. Non pitting edema resulting from hypothyroidism is a consequence of heart failure in which case cardiac output is reduced and should be accompanied with signs of heart failure which apparently she does not have or which will have to be ruled out.
However, what you should do is to;
-Confirm that the edema is non pitting by applying pressure for 5 seconds and if the tissue stays down, its pitting
-meet an internist for detail evaluation and tests such as cardiac function and renal functions.
Hope this helps and if you do not have any other query, you could close the discussion and rate the answer.
Best regards.
Above answer was peer-reviewed by
Follow-up: Suffering from hypothyroidism, diabetes, osteoarthritis. Have swollen ankle. Proper diagnosis? 17 hours later
It has been 7 days of swelling already. She did have her ECG checked and ultrasound (abdomen), urinalysis, urine culture done 3 months ago. No abnormalities were found. Uric acid was within the normal range. She has been taking homeopathic medicine for her hypothyroidism from Feb 2013.

To be exact her fasting blood sugar was 123 mg in Feb 2013 (1st week). With all these detail,

1) Is it OK to have slight swelling even now, 1.e., on 7th day too?
2) With all the medical details provided above, what could be her problem?
3) What medical tests would you further suggest?
Answered by Dr. Achuo Ascensius 16 hours later

Thanks for writing back.

From this end we can only state possible causes rather than say exactly with certainty what could be the problem as I did in our previous discussion because a good physical evaluation has to be done. Also, it would appear the tests results you have giving were done three months ago and would hardly reflect the present situation.

The duration of the swelling is a function of the underlying condition and unless it is treated it will persist; as previously discussed, causes could be variable and good physical examination is needed. Further tests will then be requested following the results of the physical examination.

So it will be advisable for her to XXXXXXX an internist for re-examination and tests following the examination.

Best regards and if you do not have further queries, you could close the discussion and rate the answer.
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