A 78-year-old female presents to the emergency department with altered mental status. Her is drowsy and confused, and her initial vitals are the following: temperature 34.5 °C heart rate 120 bpm, blood pressure 92/45 mmHg, respiration rate 12. Her initial point of care glucose is 2.5. Which of the above is NOT a clinical clue for decompensated hypothyroidism?