In which of the following patients, thyrotoxicosis should not be suspected -

In hyperthyroidism there is proximal muscle weakness.  Thyrotoxicosis (Hyperthyroidism) Most common cause of thyrotoxicosis is diffuse hyperplasia of the thyroid, i.e., Graves disease.  Clinical features Hyperthyroidism is a hypermetabolic state. The effects are due to increased level of thyroxin as well as due to overactivity of the sympathetic nervous system. Features are : Metabolism → ↑ BMR, Intolerance to heat, weight loss, increased sweating, postprandial hyperglycemia, ↓cholesterol, ↓ phospholipid, ↓ triglyceride, ↑ FFA, Increased appetite. CVS → ↑ Systolic BP, Hyperdynamic precordium, wide pulse pressure, sinus tachycardia, mid-systolic murmur, Means Lerman scratch, atrial fibrillation, Angina & CHF. Respiration → ↑ Respiratory rate. GIT → Diarrhoea CNS → Nervousness, anxiety Musculoskeletal system → Proximal muscle weakness, fine tremors, osteoporosis. Others → Extreme fatiguability but inability to sleep, infertility. In Graves disease there is exophthalmos, and wide-eyed, Staring gaze.