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

Thyrotoxicosis is a hyper metabolic state caused by elevated levels of free T3 and T4. It leads to increase in metabolic rate and heightened catabolic metabolism resulting in weight loss despite of increased appetite. It also causes cardiac manifestations like paroxysmal atrial tachycardia. Sympathetic hyper stimulation of gut causes hypermotility and diarrhea. Thus in all above cases except weakness of distal muscles one can suspect thyrotoxicosis. (ref:ROBBINS Text book of pathology endocrinology)