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What is In which of the following patients, thyrotoxicosis should not be suspected - and explain in detail?
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.