IMPORTANCE Thyroid hormones play a key role in modulating myocardial contractility. Subclinical hypothyroidism in patients with acute myocardial infarction is associated with poor prognosis.OBJECTIVE To evaluate the effect of levothyroxine treatment on left ventricular function in patients with acute myocardial infarction and subclinical hypothyroidism. DESIGN, SETTING, AND PARTICIPANTSA double-blind, randomized clinical trial conducted in 6 hospitals in the United Kingdom. Patients with acute myocardial infarction including ST-segment elevation and non-ST-segment elevation were recruited between February 2015 and December 2016, with the last participant being followed up in December 2017.INTERVENTIONS Levothyroxine treatment (n = 46) commencing at 25 μg titrated to aim for serum thyrotropin levels between 0.4 and 2.5 mU/L or identical placebo (n = 49), both provided in capsule form, once daily for 52 weeks. MAIN OUTCOMES AND MEASURESThe primary outcome measure was left ventricular ejection fraction at 52 weeks, assessed by magnetic resonance imaging, adjusted for age, sex, type of acute myocardial infarction, affected coronary artery territory, and baseline left ventricular ejection fraction. Secondary measures were left ventricular volumes, infarct size (assessed in a subgroup [n = 60]), adverse events, and patient-reported outcome measures of health status, health-related quality of life, and depression. RESULTS Among the 95 participants randomized, the mean (SD) age was 63.5 (9.5) years, 72 (76.6%) were men, and 65 (69.1%) had ST-segment elevation myocardial infarction. The median serum thyrotropin level was 5.7 mU/L (interquartile range, 4.8-7.3 mU/L) and the mean (SD) free thyroxine level was 1.14 (0.16) ng/dL. The primary outcome measurements at 52 weeks were available in 85 patients (89.5%). The mean left ventricular ejection fraction at baseline and at 52 weeks was 51.3% and 53.8%, respectively, in the levothyroxine group compared with 54.0% and 56.1%, respectively, in the placebo group (adjusted difference in groups, 0.76% [95% CI, −0.93% to 2.46%]; P = .37). None of the 6 secondary outcomes showed a significant difference between the levothyroxine and placebo treatment groups. There were 15 (33.3%) and 18 (36.7%) cardiovascular adverse events in the levothyroxine and placebo groups, respectively. CONCLUSIONS AND RELEVANCEIn this preliminary study involving patients with subclinical hypothyroidism and acute myocardial infarction, treatment with levothyroxine, compared with placebo, did not significantly improve left ventricular ejection fraction after 52 weeks. These findings do not support treatment of subclinical hypothyroidism in patients with acute myocardial infarction.

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A third each of patients with SH due to GD progress, normalize, or remain in the SH state. Older people and those with positive anti-TPO antibodies have a higher risk of progression of the disease. These novel data need to be verified and confirmed in larger cohorts and over longer periods of follow-up.

A total of 101 egg wash water samples from five different egg grading stations in eastern Ontario were analyzed for a variety of physical and chemical variables in an attempt to find a correlation with total bacterial counts. Temperature, pH, total chlorine, and percentage transmission at 600 nm (%T) were found to be significant variables, and a multiple regression equation was derived that accounted for 65% of the total variation. The equation was used to classify wash water samples as acceptable (< or = 10(5) cfu/mL) or unacceptable and correctly classified 77.2% of the samples. Classification of a second (validation) data set from 58 wash water samples was correctly predicted in 72% of the cases. The predictive value of the equation was especially good for those wash water samples obtained from stations that had used a chlorinated alkaline detergent, 90.4 and 100% for the modeling and validation data, respectively. Maintenance of wash water at recommended levels for temperature and pH (i.e., > or = 40 C and pH > or = 10) was insufficient to ensure bacterial numbers would be < or = 10(5) cfu/mL. Under normal operating conditions a minimum total available chlorine concentration of .45 mg/L should be maintained in wash water to ensure that bacterial numbers are kept at an acceptable level. Monitoring of temperature, pH, total chlorine, and %T will assist in maintaining wash water quality and minimize the number of samples returned to laboratories for microbiological analysis.