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You cannot create an instance of an interface To access the interface methods, you need to create an instance of a class that implements that interface You declare an interface much like you would a class, but using the keyword interface You can apply access modifiers to the interface, as you would with a class In the interface definition, the method declarations cannot have access modifiers To implement an interface on a class, you use the colon operator, followed by the name of the interface, similar to the syntax for inheritance Classes can derive from no more than one class, but can implement any number of interfaces If a class has a base class and one or more interfaces, the base class must be listed first (after the colon) Separate the base class and interface names by commas.

hyperthyroidism (Table 26 5) in patients who are clinically euthyroid Serum T4 is frequently low in patients with severe illness, caloric deprivation, or major surgery who have accelerated peripheral metabolism of serum T4 to reverse T3 (rT3) Furthermore, in most patients who are critically ill, there is a circulating inhibitor of thyroid hormone binding to serum thyroid-binding proteins (TBPs) This causes the RT3U to be misleadingly low, causing the computed FT4I to be very low The presence of a very low serum T4 in severe nonthyroidal illness indicates a poor prognosis Direct assays of FT4 often show low levels of FT4 in severe illness Because studies of giving replacement T4 to such patients have shown no improvement in survival, they are considered euthyroid Serum TSH tends to be suppressed in severe nonthyroidal illness, making the diagnosis of concurrent primary hypothyroidism quite difficult, although the presence of a goiter suggests the diagnosis The clinician must decide whether such severely ill patients (with a low serum T4 but nonelevated TSH) might have hypothyroidism due to pituitary insufficiency Patients without symptoms of prior brain lesion or hypopituitarism are very unlikely to suddenly develop hypopituitarism during an unrelated illness Patients with diabetes insipidus, hypopituitarism, or other signs of a central nervous system lesion may have T4 given empirically True secondary hypothyroidism due to direct dopamine suppression of TSH-secreting cells may develop in patients receiving prolonged dopamine infusions Certain antiseizure medications cause low serum FT4 levels by accelerating hepatic conversion of T4 to T3; serum TSH levels are normal

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Ando T et al Thyrotropin receptor antibodies: new insights into their actions and clinical relevance Best Pract Res Clin Endocrinol Metab 2005 Mar;19(1):33 52 [PMID: 15826921] Bowen RA et al Effect of blood collection tubes on total triiodothyronine and other laboratory assays Clin Chem 2005 Feb;51(2): 424 33 [PMID: 15576427] Helfand M; US Preventive Services Task Force Screening for subclinical thyroid dysfunction in nonpregnant adults: a summary of the evidence for the US Preventive Services Task Force Ann Intern Med 2004 Jan 20;140(2):128 41 [PMID: 14734337]

Weakness, fatigue, cold intolerance, constipation, weight change, depression, menorrhagia, hoarseness Dry skin, bradycardia, delayed return of deep tendon reflexes Anemia, hyponatremia T4 and radioactive iodine uptake usually low TSH elevated in primary hypothyroidism

Hypothyroidism is common, affecting over 1% of the general population and about 5% of individuals over age 60 years Thyroid hormone deficiency affects almost all body functions The degree of severity ranges from mild and unrecognized hypothyroid states to striking myxedema The fluid retention seen in myxedema is caused by the interstitial accumulation of hydrophilic mucopolysaccharides, which leads to lymphe-

To extend batch systems, designers added new features such as multiprogramming and spooling in an attempt to address some of the weaknesses associated with batch processing.5 These additions somewhat improved CPU usage and job scheduling, but did not address one of the fundamental problems of batch systems: the time delay between submitting a job and getting the results. Computers were costly relative to the programmer; efficiently optimizing the most costly resource (the computer) means better use of computer time, better job throughput, and lower computing costs.

When you define a class that implements an interface, you must then implement all the required members of that interface In situations where you don t know what type of object you have, and you know only that the object implements a specific interface, you can create a reference to the interface and assign the object to that reference, providing you with access to the implemented interface methods You can use the is operator to determine whether an object derives from a base class or implements an interface The is operator returns a Boolean value indicating whether the cast is valid, but it does not perform the cast The as operator attempts to cast a reference to a base type or an interface, and returns null if the cast is not valid You can extend an interface to add new methods or members.

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