Which of the following is the LEAST likely symptom of hyperthyroidism in a 77-year-old man?

One of the most important principles of caring for the older patient is the recognition that diseases present in an atypical fashion. For example, hyperthyroidism in a young or middle-aged individual usually manifests as tremor, goiter, or exophthalmos. Instead, this endocrinopathy in an older person is more likely to cause one of the "final common pathway" symptoms such as weakness, fatigue, syncope, confusion, or depression Atrial fibrillation is also a more typical presentation of hyperthyroidism in this age cohort than any of the classic symptoms or findings. The differential diagnosis of a limited number of presenting symptoms in the elderly is both broad and similar amongst several syndromes: incontinence, falling, syncope, and confusion. More over, due to decreased physiologic reserve in the elderly, patients often present at an earlier stage of the disease.