Photoshop Elements Q: file size increases when saved

Photoshop Elements 6.0, Windows XP.

I wanted to make a minor change to a PDF file I have received, just add some text. When I did, the saved file expanded from 10 MB to 14 MB, even though I flattened the layers and saved it at medium low picture quality. (With low quality, compression artifacts were very noticeable.) If I saved it with no compression, it expanded to 42 MB!!!

Why can’t I make a minor change and save the file in a size that is virtually identical in size to the original?