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The FT4 may be low or low-normal Serum TSH is increased with primary hypothyroidism but is low or normal with pituitary insufficiency Other laboratory abnormalities may often be seen: increased serum cholesterol, liver enzymes, and creatine kinase; increased serum PRL; and hyponatremia, hypoglycemia, and anemia (with normal or increased mean corpuscular volume) Titers of antibodies against thyroperoxidase and thyroglobulin are high in patients with Hashimoto s thyroiditis Serum T3 is not a good test for hypothyroidism The normal range for ultrasensitive TSH levels is generally stated to be 04 55 mU/L However, over 95% of normal individuals have serum TSH concentrations under 30 mU/L There is a high risk of finding antithyroid antibodies in patients with serum TSH in the upper range of normal (30 55 mU/L), but most such patients are asymptomatic TSH may be mildly elevated in some euthyroid individuals, especially elderly women (10% incidence) Such patients with normal FT4 levels must be evaluated carefully for subtle signs of hypothyroidism (eg, fatigue, depression, hyperlipidemia) About 18% later become definitely hypothyroid

A different approach, which directly addressed the time-delay problem and influenced UNIX, BSD, and future systems, was time-sharing. The idea of time-sharing began to surface in the mid-1950s and grew to have two meanings. In the paper An Experimental Time-Sharing System, Corbat , Merwin-Daggett, and Daley describe time-sharing as follows:

common use. However, the array isn t the only collection class in C#. In fact, although arrays are simplest to understand, which is why we introduced them first, in many ways they re the most limited of the collection classes. In the next chapter, you ll learn about the other collection classes, and how you can use them with generics to get even more flexibility.

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received central nervous system radiation for leukemia have a 15% chance of developing hypothyroidism years later Patients with primary pulmonary hypertension have a 22% incidence of hypothyroidism Amiodarone, because of its high iodine content, causes clinically significant hypothyroidism in about 8% of patients The T4 level is normal or low, and the TSH is elevated, usually over 20 ng/dL Another 17% of patients develop milder elevations of TSH and are asymptomatic Low-dose amiodarone is less likely to cause hypothyroidism Cardiac patients with amiodarone-induced symptomatic hypothyroidism are treated with just enough T4 to relieve symptoms Hypothyroidism usually resolves if amiodarone is discontinued Hypothyroidism may also develop in patients with a high iodine intake from other sources, especially if they have underlying lymphocytic thyroiditis Patients with chronic hepatitis C have an increased risk of autoimmune thyroiditis, with 21% having antithyroid antibodies and 13% having hypothyroidism The risk of thyroid dysfunction is even higher when patients are treated with interferon Interferon- and interferon- treatment can induce thyroid dysfunction (usually hypothyroidism, sometimes hyperthyroidism) in 6% of patients Spontaneous resolution occurs in over 50% of cases once interferon is discontinued

Many clinical manifestations of hypothyroidism (see above) are common in the general population without thyroid illness Patients with such symptoms need to be screened for hypothyroidism (see Table 26 3) The real differential diagnoses are the conditions and drugs that can cause abberations in laboratory tests, resulting in a low serum T4 or T3 or high serum TSH in the absence of hypothyroidism (see Table 26 4) The pituitary is often quite enlarged in primary hypothyroidism due to reversible hyperplasia of TSH-secreting cells; the concomitant hyperprolactinemia seen in hypothyroidism can lead to the mistaken diagnosis of a TSHsecreting or PRL-secreting pituitary adenoma

These may vary from the rather rare full-blown myxedema to mild states of hypothyroidism, which are far more common Hypothyroidism is a common disorder; therefore, a clinician should request thyroid function tests for any patient with the nonspecific symptoms and signs of hypothyroidism

Question 13-1. What is the difference between an interface and a class that implements an interface Question 13-2. What is the difference between an interface and an abstract base class Question 13-3. How do you create an instance of an interface Question 13-4. How do you indicate that class MyClass derives from class MyBase and implements the interfaces ISuppose and IDo Question 13-5. What two operators can tell you whether an object s class implements an interface Question 13-6. What is the difference between the is and as operators Question 13-7. What does it mean to extend an interface Question 13-8. What is the syntax for extending an interface Question 13-9. What does it mean to override an interface implementation Question 13-10. What is explicit interface implementation and why would you use it

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