The most important thing is to make sure you've disabled all the features you don't need in config.h. The default configuration enables most cryptographic mechanisms, but typical constrained systems usually only need a few.
If your toolchain supports it, use link-time optimization (e.g. gcc -Os -flto or clang -Oz -flto). I've seen that this makes a significant improvement for Mbed TLS (I got -30% on one build, obviously the numbers depend heavily on the configuration and the compiler). (In contrast LTO when optimizing for performance doesn't seem to improve anything.)
MBEDTLS_MPI_WINDOW_SIZE, MBEDTLS_MPI_MAX_SIZE and MBEDTLS_ECP_MAX_BITS only impact memory usage (stack and heap), not code size.