S2 E2: Supporting Optimal Thyroid Health with Kaely, RD


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Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.

Amanda: In this episode, we are diving deeper into how the thyroid functions, what impacts it, and how you can support optimal thyroid health. To cover this topic. I’m joined by Kaely McDevitt. Kaely is a registered dietitian specializing in women’s health. She owns a virtual private practice where she and her team help their clients overcome hormone and digestive issues through personalized nutrition. Having experienced the pitfalls of a conventional approach to women’s health firsthand, Kaely is passionate about empowering women to take the driver’s seat over their health and well-being.

You guys, if you’ve been listening to the podcast for a little while, you’ll definitely remember Kaely. She was actually on for episode 18, and she helped us break down, like, what the stress response is in the body and how we can help our bodies improve that resilience and the ability to handle stress. So definitely check out episode 18 if you haven’t already—you’re going to learn that it’s, stress is very connected to thyroid health. We’re going to talk about that today. But thank you so much for being with me, Kaely.

Kaely: Yeah, thanks for having me back again.

Amanda: I know I was like, who are we going to talk about thyroid health with? And Kaely is actually the person that introduced me to iodine testing and utilizing iodine therapy. And that’s basically changed my life as I’m sure we’ll talk about. So I was like, we got to have Kaely on to spread thyroid knowledge.

Kaely: I was excited to chat about it. And like you mentioned, it’s like such a good piggyback off of our last convo on here.

Amanda: Yeah, and one thing if you guys, like, haven’t heard Kaely’s story, she talked about it pretty in depth on the last one. It’s pretty similar to mine with the whole birth control piece. One of the other big reasons is the majority, I would say majority of your clients probably have thyroid issues. Do you see that a lot?

Kaely: Oh, yeah, a vast majority, whether it’s actually diagnosed or just in symptoms and not yet diagnosed. We see a lot of hypothyroid specifically type symptoms.

Amanda: Yeah, and I feel like hypothyroidism or honestly, like, any thyroid issue is just not diagnosed often unless it’s really, really bad and far gone. So do you want to give us some background? We’ll start with like, what does our thyroid do, because I think people think of thyroid health and they’re like, well, I don’t have a thyroid issue. And I’m like, but, like, you, you could have this other mineral deficiency or imbalance or something that is impacting how your thyroid is functioning. And it just hasn’t shown up on your lab work yet. And we’ll talk about how to test your thyroid at the end. But what is our thyroid actually do in the body?

Kaely: Yeah, so the thyroid is like a butterfly-shaped gland at the front of your neck. And it’s an endocrine gland which means it secretes hormones that communicate with other cells and tissues in the body. And for the most part the thyroid is setting like the metabolic pace of your body. So nearly every cell has a receptor for thyroid hormone, which means what’s happening in that gland is affecting everything else in the body, like, wide-ranging effects from hormones to digestion, to brain health and development. Really nothing that the thyroid is not influential upon, because it’s setting the rate at which the rest of our cells do their things. So I think, like you mentioned, it’s common to treat thyroid issues as, like, kind of an isolated thing or a secondary thing. But really the thyroid function being optimal is the route of optimal health, because we can’t have a healthy metabolism without a healthy thyroid.

Amanda: Specifically, how… I love I actually wrote down setting the metabolic pace for your body. I really liked that. I was like, that was a perfect way to describe what the thyroid does. I will definitely put that in one of the social media posts for this episode. And sometimes I feel like that concept can almost be so big that we’re like, okay, great, like, what is that even mean? Or how is that going to show up for me symptom-wise? So how, how can we connect the thyroid with things like our digestion and our hormones? How is it specifically going to impact those parts of the body?

Kaely: Yeah so we talked about pace. And I think, like, thinking about the pace of things being tied to the thyroid is a helpful way to connect these dots, particularly when we’re talking about digestion. So we have something called peristalsis, which is like coordinated muscle contractions that keep things moving through your GI tract. Now when the thyroid is underactive, so slowed pace, we have a slowed pace of peristalsis. So we now are not moving things through as efficiently or as timely as we should, which makes digestive symptoms much more likely. So bloating, gas, indigestion, it also makes things like SIBO, so small intestinal bacterial overgrowth, more likely. Constipation is super common with hypothyroidism because again, things are just moving really slow. There’s also a big impact on, like, bile flow and function with hypothyroidism. Which, aside from iodine, another passion area of mine is gallbladder so I had to bring that in. But if we’re impairing bile flow, now we’re not absorbing particularly fats and fat-soluble vitamins very well, but that’s also an important detox route for us.

Your thyroid is intimately related to sex hormones, too. So not only is it controlling the speed and efficiency at which sex hormones are made, but we’re also having a direct relationship between thyroid output and progesterone production. And that goes both ways. I know we’ll get into that later. And then really, when we think about the thyroid’s effects on, like, stress and sex hormones that OAT or OAT axis, ovarian adrenal thyroid axis is a helpful way to remember that. And I know Amanda has really great graphics on this that I’m sure she’ll link to, but basically your adrenal axis, your thyroid axis, and your ovarian axis are all intimately related and get feedback from one another. So any issues in any one of those areas is going to spread to the other. So when we’ve got thyroid stuff going on, we’re also likely to have adrenal and sex hormone stuff too.

Amanda: Again, I see so many women that are like, I can’t get rid of, like, this estrogen and progesterone imbalance or these gut issues, I really get SIBO over and over, you know, no, no matter how many like crazy intense like gut protocols I do. And it, the issue comes up where their thyroid is they’re like, oh, no, it’s not my thyroid, my thyroid looks normal on bloodwork. And it’s like, okay, but that, that’s only one way to look at your thyroid. And then if you ask them, like, oh, are you cold frequently, you know, how’s your basal body temperature, that sort of thing. They’ll have, like, all the other signs of hypothyroidism, but just because it doesn’t match up to their labs, it’s like, well, that’s definitely not the issue. And it just kind of shows you, and I, I’ve said this so many times, people are probably, like, gonna be so angry, like, stop saying that on this podcast—but everything is connected, nothing is happening in isolation.

And it’s one of the reasons we want to do this whole series on your thyroid is because it is so connected to everything else. And it’s one of those parts of the systems in the body where it’s, like, unless it’s really, really off, it’s really hard to get help with. I love that you talked about the OAT axis—I think that’s essential. Like, they all impact each other, right? It’s not like, we have, like, having adequate progesterone, like, that’s going to be helpful for your thyroid, but having adequate thyroid hormone that’s going to impact that. Thyroid impacts our cholesterol, you know. High cholesterol is usually one of the first things I’ll see on lab work that’s, like, yelling that, hey, your thyroid probably needs some help.

So what is going to impact how our thyroid functions? I think this is where some of the confusion can come in. Where it’s like, well, I don’t have hypothyroidism, like, they don’t have an actual issue with the gland. But what are some other things that can impact how our thyroid works, especially when it comes to nutrition?

Kaely: Yeah, for sure. So really, when we think about a healthy metabolism—and I know we talked about this extensively on our first interview together—but it really comes down to whether or not the body’s feeling safe, right. If a body’s not feeling safe, we get into, like, energy conservation mode where we’re not going to want to be revving up metabolism because we want to conserve energy. So from a food standpoint, if we’re undereating chronically, that is a really strong signal to the brain and then, therefore, the thyroid, that now’s not the time to crank out more thyroid hormone, because then we’re going to start burning through fuel faster and there’s not enough coming in in the first place.

So the first thing that we work up in any client with suboptimal thyroid function is are we eating enough consistently? From there we move on to making sure blood sugar is balanced. So carbs, proteins, fats together at regular predictable intervals throughout the day. Making sure that breakfast is happening within an hour of waking and not before, or before coffee, not coffee first, because that’s a really significant stress on the body too. So if our blood sugar’s swinging all over the place, particularly those lows, that’s enough stress to slow thyroid function. And then once we’ve got those two avenues carried away, we start to talk about individual nutrients and certain types of foods. We find, like, animal proteins being particularly helpful here. So, you know, one of the main ingredients of thyroid hormone is an amino acid called tyrosine. So we’ve got to be getting enough proteins that contain tyrosine. With animal proteins and organ meats, if you’re up for it, we also get vitamin A in an important retinol form, which is part of this whole equation for a happy thyroid too. And then lots of mineral-rich fruits and veggies and adequate carbohydrates would be kind of our general nutrition approach to thyroid health.

Amanda: One thing I often see is women that have been dieting for a really long time, and then all of a sudden it’s like 5-10 years later, then they have the thyroid issue. And it could be that it’s actually diagnosed, maybe they’re like, well my blood work’s not terrible but it’s not amazing either. What is, how is that dieting and different type of diets, how is that gonna impact? Obviously you talked about undereating in general, but can different types also impact thyroid function?

Kaely: For sure. So if we do, like, chronic low fat dieting—which that’s really not the craze anymore which is nice, but it definitely was when we were in school and, you know, years prior to that—you know, we’re jeopardizing healthy fats and therefore fat-soluble vitamins. So the vitamin A is a really important piece of our whole thyroid conversation. And deficiencies in vitamin A is pretty well cited in the research to correlate with increased TSH, which is a sign of underactive thyroid hormone. We also with low carb dieting, which I would say is more common now over the last several decades, we run into some issues with thyroid hormone output too. Really at any intake less than about 150 grams per day, we start to potentially see decrease thyroid hormone output. Again, it depends a lot on the individual and what else is going on in their life, but any form of diet is a stress on the body. And that’s all liable to affect thyroid hormone output.

Amanda: I find, like, plant-based or vegan diets, it’s so tricky, because like you said, like, vitamin A in the retinol form. So that’s the form that we’re going to get from animal foods. We know now that that is essential for thyroid health. I’ve done like many posts on that. I’ll have to, and I have a blog I’ll link in the show notes. So we know vitamin A is essential, so that’s like my first thought with plant-based and, like, vegan diets. But the protein is also really important.

Kaely: The potential for goitrogens being high when we’re on a plant-based diet, too, is potentially part of the problem. And that’s really just a group of foods that can block iodine uptake by the thyroid. So we’re looking at some cruciferous veggies in, like, high quantities, particularly if eaten raw, and even soy being part of that problem, too. So oftentimes, our plant-based clients are getting the majority if not all of their protein from soy sources. So potentially an issue there too.

Amanda: It’s tricky. And then I think of, like, we need amino acids to do everything else in the body. So are the symptoms coming from thyroid? Are they coming from the lack of protein? Like, who knows? But I think that’s an important distinction. And it’s, like, we have to eat enough and having that balanced amount. Like, when I look at thyroid health, it’s basically the same for hormone health, in that we don’t want to go to extremes—like that’s the goal, it’s just not to go to extremes with your diet, and that will stress your body out less.

Kaely: Amen. It’s the exact same.

Amanda: And then when you talked about, like, eating regularly, like, having that meal consistency throughout the day, I think one of the things people often, like, miss out on with thyroid is that, like…though, if you’re extending those meal times one, you might not really be able to, because when we have thyroid issues we can actually have a hard time storing glucose in our liver, as that glycogen. And so you might not have as much glycogen to keep your blood sugar stable between meals or at night. If you’re waking up and stuff at night, that can be a big red flag too. And in order to replenish that glycogen, it’s, like, eating every three to four hours is really helpful. And so I’m always like, if you have thyroid issues or any concern or history, it’s, like, try to eat consistently. And sometimes we can just take that advice and like, yeah, like, I’ll try. But I’m like no, like, really listen to that one. It sounds simple. But I would say that’s probably one of the best ways. Like, you talked about blood sugar, it’s, it’s the same thing. It’s, like, it’s going to reduce that stress, but it’s also going to replenish that glycogen so that hopefully you can sleep through the night, you can have good energy, all that kind of stuff.

Kaely: For sure. And none of the rest of the thyroid support tips really do much for you in the absence of that solid nutrition. So it’s, like, that has to be laid as a foundation first before you get fancier with it. And that’s for some reason a hard message to receive. It certainly was for me back in the day too. I’m like, yeah, I’m fine, I don’t have to pay that close attention to it. But it makes a world of difference.

Amanda: Yeah, and even I talked about this with my friend Jillian, we had like a PCOS, like, blood sugar podcast episode. And there’s, there’s a lot with, like, how your thyroid impacts insulin resistance and how that insulin resistance impacts thyroid hormone. So it’s like, it’s, it’s, it’s important for both things. But I find so many women with PCOS have hypothyroidism or struggle with their thyroid. So it’s, like, either way, it’s really important. And if you have insulin resistance on top of thyroid issues, then eating more frequently is even more important. Because the more insulin resistant you are, the harder the time you’re going to have getting nutrients inside the cells and then it’s, like, your thyroid needs a lot of nutrients.

And that’s what I want to dig into next. We talked about vitamin A. What are some other really important micronutrients for thyroid?

Kaely: So I don’t think we can talk about really anything without mentioning magnesium. I think it’s on the list for anything that needs support. But specific to the thyroid, magnesium is part of what gets iodine to the thyroid gland. So that’s, like, first step in the production sequence of thyroid hormone, so that’s super important. And then it’s also protecting against oxidative stress later on in some of the steps that iodine must undergo before it can become thyroid hormone. Not to mention, we talked a lot about how impactful stress can be on thyroid function and magnesium being like nature’s anti stress. So magnesium is a big part of that.

Sodium and potassium, really, so we’re hitting, like, our foundational minerals here, but sodium is involved in that iodine transport as well. There’s something called the sodium iodide symporter, or like the NIS, that I know we’ll talk about a little bit more. So without sufficient sodium, again, we can’t get iodine where it needs to go. And then potassium is really helpful when it gets to actually getting thyroid hormone into the cell. So helping to sensitize the cells to, like, uptaking thyroid hormone. So you had mentioned, sometimes people have hypothyroid symptoms but their labs look normal. And you can have that when we have cellular hypothyroid, where we actually are making plenty of thyroid hormone, but we can’t get it into the cell and potassium is part of that.

We also have iron in the mix, with caution, but iron in the right place and used correctly is really helpful for converting inactive T4 to active T3. It’s necessary for TPO, or thyroid peroxidase enzyme, too, which is part of the whole way we process iodine in order to make thyroid hormone. Selenium is a big one, again, part of the conversion of T4 to T3, and also it’s helping to make sure that we mitigate the oxidative stress that’s formed when we process iodine. We’ve got copper and zinc in the mix. Feel like I might be…oh, and iodine, of course, a big piece of that formula. I’m like, I know I’m missing one, the most important one. We use iodine to make thyroid hormone. So you’ve probably seen T4 and T3, if you, if you’re lucky you’ve seen T4 and T3 on your thyroid labs. And that literally correlates to how many molecules of iodine are present. So T4 is four molecules of iodine T3 is three. So iodine is absolutely crucial. Like, if we don’t have enough iodine, we’re simply not making thyroid hormone.

Amanda: And I think the biggest thing to keep in mind, because people, they love hearing the isolated nutrients and they’re like, perfect I’ll supplement with all those nutrients, right, like I’ll just do that. But it’s, in reality they all work together. Like, you talked about sodium, how that we need that for the iodide symporter and making sure that we can uptake and transport that iodine. And then magnesium, same thing, like, carries the iodine there. So when it comes to the micronutrients, how do you find is, like, the best way for people to get them in?

Kaely: Yeah, so I like mineral-rich fruits and veggies. So, you know fruits, root vegetables, those kinds of things. And then of course, making, like, adrenal cocktails or other mineral beverages makes it really easy to get more sodium, potassium, and magnesium in particularly. You also get some vitamin C that way too if you go the adrenal cocktail route, which is helpful for the thyroid as well. There’s a lot of oxidative stress that can happen in the production of thyroid hormones, so the more antioxidants typically the better. And then if you’re open to it, incorporating, like, either full fat dairy or some grass-fed organ meats, things to help make sure we’re getting that vitamin A would be really helpful. You’re also going to be getting zinc and copper and even some iron in all the right ratios if we go with those foods too. And then iodine, from a food standpoint, we can get from grass-fed dairy, we can get from seafood, of course, and seaweed, kelp flakes, those kinds of things. And then in certain instances does need to be supplemented, but we’ll get into that a bit.

Amanda: I think that’s the biggest thing is when you’re eating those nutrient-dense foods. That’s why I like that, I love the mix of animal and plant foods. I think that gives us the most nutrients and the most bang for our buck when we’re eating. It’s, it’s more of, like, when I think of clients that have struggled with this, it’s people that are coming from a restrictive background. Whether that is undereating, lots of dieting, or like lots of elimination diets, lots of food sensitivity testing, and saying that they can’t eat X, Y, and Z. And so they’ve eliminated all these food sources of nutrients.

Kaely: Yep. And you can see why you would get stuck in like a ferris wheel of never-ending symptoms. Because let’s say it’s digestive symptoms, and you do food sensitivity testing or go on these really intense protocols. And you’re pulling so many foods out, when we need the energy production of a healthy thyroid to even be able to heal and to get digestion moving normally, but we can’t get access to the nutrients we need because we’re on such a restricted diet and it just keeps going around.

Amanda: My head keeps going back to the gallbladder thing. This is, so this is, like, a little off topic, but I’m like, I feel like I need to ask about this. So, because now I’m thinking back to a lot of my clients that have, are diagnosed with hypothyroidism, and a lot of them don’t have gall bladders. Do you see that a lot?

Kaely: Yes, and it’s like a chicken or the egg situation with that for sure. But yeah, lots of, like, subclinical hypothyroidism for years could have been enough to create problems in the gallbladder. And it’s pretty crazy when you look at, like, known risk factors for gallstone formation, like, how common that is, like, hormonal birth controls is high up on that list. I had no idea. And then hypothyroidism is high up on that list, too, because anything that’s slowing the flow of bile makes the risk of stone formation higher. And then we also get an increased concentration of cholesterol in that bile because we’ve messed with cholesterol metabolism. And then actually T4 influences the relaxation of that sphincter of Oddi, which is part of, like, bile release. So if that can’t relax and release bile, it stays stuck and gets sludgy. So, yeah, big hypothyroidism gallbladder issue connection.

Amanda: Because now I’m, like, I mean, most of those people have hormone issues and they’ve been on birth control and stuff like that. And, like, of course, birth control is really common, like, leading to getting your gallbladder removed. And hormone imbalances in general, like, I think a lot of them have PCOS. But I’m like, oh my gosh, you know a lot about the bile connection. Now I’m like, this is something I didn’t really, I knew that it could mess with the flow. I didn’t know to the extent and I did not know that T4 controlled that sphincter that is…

Kaely: Isn’t that interesting?

Amanda: Do you have a highlight on your Instagram?

Kaely: I don’t, but I should. I’m going to talk about this this week, because I realized that I don’t think I have. I have a lot to say on that topic. So I will.

Amanda: Because you have some amazing posts on bile and gallbladder. So if you make a highlight, I’ll put it in the show notes. I’m going to make myself a note now. So bile highlights, so I’ll make sure that I grabbed that, just because it is a topic where I feel like people are kind of only concerned with their gallbladder if it’s been removed, and bile. But if you have thyroid issues and digestive issues, kind of a classic, like, supporting digestion, has it helped, you might need to look a little bit deeper into that bile. Thanks for the side tangent.

Okay, so we talked about the micronutrients where you can get them in foods, even, like, you know, adrenal cocktails, I’ll put the blog for that if you’re like, what the heck is an adrenal cocktail? We talked about this in another episode as well. It’s just, like, a mix of sodium, potassium, and whole food vitamin C in delicious drinks. Let’s talk now since we kind of know what our thyroid needs, how it’s going to impact our digestion and hormones. How does stress impact how our thyroid functions? You talked about this in the beginning, and especially specifically to blood sugar, but how is stress in general going to impact how that thyroid works?

Kaely: So that input of stress, again, comes back to whether or not the body’s feeling safe. I feel like that’s probably my most used phrase in any talk that I have. And when the body doesn’t feel safe, we’re going to slow energy production down. So we do get a direct effect on the thyroid output from that standpoint. And we talked about that OAT axis before about how there’s an inner relationship between adrenal, ovarian, and thyroid function. And when we’ve got a really revved up HPA axis, so this was the one talking about adrenals and stress, and the end result of a revved up HPA axis is boatloads of cortisol, our stress hormone, in circulation. We actually get a blunting of our TSH, thyroid stimulating hormone, when there’s an abundance of cortisol around. So this gets people in a tricky situation because almost always, unless you request more, your thyroid testing will only be TSH. And that’s like the very tip of the iceberg when it comes to what’s happening with the thyroid. But when cortisol is high TSH will be low, because we have that negative feedback loop, which means your thyroid labs will look good if we’re only looking at TSH when stress is high. And I’d say you probably agree with this too, most of my clients that are not feeling well stress is high and they’ve got hypothyroidism symptoms, but they’ve been told that it’s normal because TSH looked good.

Amanda: Yeah, and then once they start making changes, like, food changes, supplement changes, reducing their stress, their TSH goes up and they freak out. They’re like, what the heck, I feel so much better, but my TSH got worse. And it’s like, that’s because you don’t have a bunch of cortisol reducing your TSH levels. And I think that’s a, this is an important one to remember. Because it can be really hard to advocate for yourself when you’re at the doctor or working with whatever practitioner you’re working with. And they’re like, no, TSH looks good so it’s not your thyroid. This is when you want to think about, but it’s interesting because there’s so many different things that can impact my thyroid and we know that our thyroid is gonna trickle down and impact digestion and hormone production and detox and metabolism and all that stuff.

So it’s, that’s when it’s, like, you do want to look further. And we’re going to talk about that when we go into the labs, but that was my big thing. I was like, I want to emphasize that your, your TSH and your thyroid can look normal. And this is like a short-term thing. Eventually, once it gets, like, really off and once you’ve been stressed for a super long time, typically that’s when it’ll go up and then you’re going to get that diagnosis. But it’s, it’s an important one to remember. Same thing with, like, your reverse T3 values. If you get your reverse T3 checked on blood work, then that’s, like, a sign of, like, excessive and, like, chronic stress and that’s just going to put the brakes on that thyroid hormone.

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Hey, Amanda here, just giving you a quick break, hopefully a break for your brain in the middle of this podcast episode to remind you that if you haven’t gone through our free training, Optimizing Hormone Health Through Mineral Balance, we really do recommend starting there. And the main reason for that is because you’re going to hear us say things like mineral foundation, having a solid foundation, are you putting the foundations in place, especially as we get deeper and deeper into different hormonal topics and specific imbalances in the body. The mineral foundation is always going to be so essential. So if you haven’t watched the free training, you can find it in our show notes or you can go to hormonehealingrd.com and it’s going to be right on that front page there. But we really recommend starting there so that you can understand how is your current mineral status, how do you assess this, and how to get started with all that just so you can get as much as you possibly can out of the rest of the podcast episodes. But that’s it. I hope you enjoy the rest of this episode.

Amanda: So we talked about nutrition diets, specifically certain micronutrients, stress, we know stress will, like, blunt, the thyroid, make it look normal, but it’s actually, that’s not a good thing. So we need thyroid hormone, so we don’t want your TSH to go, like, way down. What about things in our environment, specifically, halogens? How do they impact thyroid function?

Kaely: Yes, so halogens, if you took any kind of, like, science class in high school, you may remember the periodic table and the halogens are all elements in the same column. So iodine is part of that. We also have fluorine, bromine, and chlorine being the most common ones that we’re getting exposed to. And so the more we are exposed to those, the more likely those halogens are to take spots on iodine receptors. So all the halogens are going to look, like, chemically very similar and act similar in the body and take up the same receptors. So because we get exposed to a ton of those on a daily basis from things like dental products, water—both drinking water or water that we use for cooking and even in our shower—and processed goods, particularly processed baked goods has bromine in the flour. And then of course, we’ve got chemicals elsewhere, like furniture and flame retardants and all kinds of fun stuff. But we’re getting a lot of halogen exposure, but not a lot of iodine intake in our diet. So we have these halogens taking seats on iodine receptors in the body, which only increases our need for iodine. So the body can’t use fluorine to make thyroid hormone. So fluorine is taking up the iodine receptor. Now we can’t get the iodine in the

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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