<prompt> In which of the following patients, thyrotoxicosis should not be suspected -Patients with unexplained weight lossPatients with unexplained diarrhoeaPatients with distal muscle weaknessPatients with paroxysmal atrial tachycardia  <response>: In hyperthyroidism there is proximal muscle weakness. Thyrotoxicosis HyperthyroidismMost common cause of thyrotoxicosis is diffuse hyperplasia of the thyroid, i.e., Graves disease. Clinical featuresHyperthyroidism 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 DiarrhoeaCNS Nervousness, anxietyMusculoskeletal 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. 