Sensation of generalized body heaviness

Specialty: General.

• heavy body
• feeling of lead in the body
• generalized heaviness of the extremities

Why it occurs

• Atypical depression or bipolar disorder in the depressive phase (with the characteristic symptom of "lead palsy", where the extremities feel extremely heavy)
• Moderate to severe primary hypothyroidism (non-depressible generalized interstitial edema or myxedema due to accumulation of glycosaminoglycans that increases physical resistance to movement)
• Incipient systemic lymphatic or venous circulation disorders (deep bilateral chronic venous insufficiency that generates a sensation of heaviness in the legs that extends to the trunk)
• Severe obstructive sleep apnea syndrome (global nocturnal tissue hypoxia that generates deep muscular physical fatigue perceived as morning heaviness)
• Myopathies due to lipid or glycogen storage (which alter the capacity for rapid muscle contraction, simulating extreme heaviness).

Initial workup

Thyroid profile (TSH, free T4), bilateral lower limb venous Doppler ultrasound, nerve conduction velocity and electromyography, urinalysis to rule out massive proteinuria, and nocturnal polysomnography.

Standard management

• Levothyroxine — individually adjusted dosage if there is confirmed hypothyroidism
• Venotonics such as the micronized purified flavonoid fraction — Diosmin 450 mg / Hesperidin 50 mg, one tablet every 12 hours orally if the heaviness has a prominent peripheral venous component
• Serotonin modulators such as sertraline (50 mg per day orally if atypical depression with leaden palsy is diagnosed).