http://youtu.be/ZEJzjJGLWjE
Hey, people! Here’s a post I originally wrote for Hypothyroidmom as a guest post. I decided to make a video of it, as well for all you video fans.
As I’m sure you know, one of the most common concerns for people with Hashimoto’s and hypothyroidism is maintaining proper body weight.
For people with Hashimoto’s (the most common cause of hypothyroidism) this comes in 2 varieties. They gain weight and can’t lose it or they have trouble keeping it on.
In this post we will examine the many reasons why a lot of people with hypothyroidism have difficulty losing weight.
One of the obvious things that people think about with hypothyroidism and weight gain is the fact that the thyroid has an impact on the body’s metabolic rate.
What is metabolism, anyway? In technical terms, its the amount of oxygen used by the body over a particular amount of time. When this measurement is made at rest, it is called the basal metabolic rate or BMR.
Testing BMR was, once upon a time, used to assess a patient’s thyroid status. Those with lower BMRs were found to have underactive thyroids and those with overactive thyroids were found to have high BMRs.
Later studies showed that low thyroid hormone levels were linked to low BMRs. Then, most physicians decided to scrap testing BMR in favor of simply testing thyroid hormone levels because it is easier and it was found that the thyroid was not the only thing to influence metabolism.
High or low BMRs are associated with changes in energy balance. Energy balance comes down to the difference between how many calories one eats and how many calories one’s body burns.
Things that create a high BMR, like amphetamines for example, often cause a negative energy balance which results in weight loss. (This is one reason why you tend not to see many overweight speed freaks.)
Based on this, many people originally assumed that changes in thyroid hormone levels which can lead to changes in BMR should lead to the same changes and the same weight losses (Minus the lost teeth and paranoia).
Well, as with most things related to the body, it turns out that its more complicated than that. Other hormones, proteins and neurotransmitters have also been found to be part of the mix and these all also have influence on energy, food intake and body weight.
Some of them that are worth taking a look at and dealing with are leptin, insulin, neuropeptide Y, serotonin and inflammatory proteins like interleukin 6 (IL-6).
Physiologically, evolution takes quite a long time (relative to our sweet, short lives). And our ancestors evolved in a calorie poor environment where fat was pretty hard to come by.
As a hunter gatherer on the open plains of Africa, our forefathers (and foremothers) had to expend a lot of energy to get food and there wasn’t a whole lot of fat around.
Most prey was pretty lean and grass fed and there weren’t too many fast food joints (The fossil record has yet to reveal a single Mickey D’s).
As a result, our bodies developed a natural tendency to store whatever fat was available. And that fat got programmed with some pretty ingenious innate intelligence.
One of those ingenious adaptations from the clever mind of fat is the hormone leptin.
Leptin is a hormone that is made in your fat cells and it is involved in maintaining body weight. Interestingly enough, it also has influence on the thyroid.
Leptin acts as an important control system that communicates to other organs about the state of your fat balance and whether to eat more or stay in low-metabolism survival state. (Where, oh where, have all the wildebeest gone?)
When you have more fat cells, you get higher leptin levels.
The high leptin lets your hypothalamus (a kind of master endocrine gland in your brain) know that you don’t need to eat as much, so metabolism slows (and this signals you to make more Thyrotropin-releasing hormone (TRH), and this raises TSH) and the TSH tells your thyroid to make more thyroid hormone.
This is what happens when everything is working properly. But with Hashimoto’s and hypothyroidism, lots of things are often not working properly and many people develop leptin resistance.
You may have heard of insulin resistance (if you haven’t, read about it here). Well, leptin resistance is similar and often co-exists. In fact, both are consequences of obesity.
With insulin resistance your body’s insulin receptors get fatigued because they have to deal with so much sugar. (They just give up and say “Uncle”). A lot of people in the US, today, has some degree of this.
With hypothyroidism, people often become overweight and use less energy. The increased amounts of fat and the lower energy use can result in leptin resistance and you wind up with a vicious cycle where leptin stops doing its job.
Its stops telling you when to eat and it stops signaling your thyroid.
Of course, many people’s natural inclination when they gain weight is to go on a diet to try and lose it. Often these people will keep dieting and fail and then diet again and get all stressed out about it because its not working.
And guess what? Chronic dieting and/or major stress are common causes of leptin resistance.
As a result, leptin no longer signals your hypothalamus and your metabolism slows down.
Leptin resistance makes the hypothalamus believe that you are in starvation mode, and you make more fat, and slow down thyroid hormone production.
So, TSH goes down, you don’t convert as much T3 from T4, and your reverse T3 goes up. And, in what can only be described as unfair and cruel, your appetite actually increases, you can also become insulin resistant, and fat breakdown (lipolysis) slows down.
So a vicious cycle is created in which more fat accumulates, you’re hungrier and your thyroid is slower.
Over time, you gain weight, especially around the mid-section, and it becomes more difficult to lose the weight and accumulated fat.
With Hashimoto’s (and hypothyroidism) one of the most serious problems is inflammation. In fact, a destructive inflammatory process is really what is at the root of all autoimmune diseases (of which Hashimoto’s is one.)
Leptin controls and influences the immune system, too. It is chemically very similar in structure to IL-6, which is an inflammatory cytokine (immune protein) that studies have shown to be significantly elevated in women with Hashimoto’s.
One of the places where can find high concentrations of IL-6 is in the fat that accumulates around the abdomen. This adipose tissue is highly inflammatory and can, itself, lead to the progression and more aggressive proliferation of many diseases.
Low vitamin D has also been associated with both insulin and leptin resistance. And vitamin D is an important anti-inflammatory that is often low in people with hypothyroidism.
Your perception of hunger is intimately linked to your brain chemistry. Normally, when things are working properly, your hypothalamus gets signals that you need energy and a brain neurotransmitter called neuropeptide Y (NPY- not to be confused with NYPD) is released.
It makes you you want to eat more carbohydrates (think overwhelming urge to finish that can of Pringles). That surge is what makes you feel cravings and hunger.
Once your body has had enough carbohydrates, the brain releases serotonin which is your brain’s way of saying, “Put down the bag and step away from the counter.”
Studies have shown that NPY is an important go between of leptin in the central nervous system and the hypothalamus. And that giving people NPY suppressed circulating levels of thyroid hormone (T(3) and T(4)) and resulted in an inappropriately normal or low TSH.
So, high levels of NPY can actually lead to functional hypothyroidism. And leptin’s job is to suppress NPY. So once again, we have the makings of another vicious cycle.
This also may be yet another reason why TSH testing can be unreliable in circumstances involving leptin and insulin resistance and weight gain due to hypothyroidism. (A set of circumstances that is ridiculously common.)
Another neurotransmitter that is impacted by hypothyroidism is serotonin. As we saw above, one of the many roles of serotonin is to tell you to stop eating those crazy carbohydrates.
Thyroid hormone and serotonin have an intimate relationship and many studies have shown that thyroid hormones impact virtually all neurotransmitters in the brain.
So, with hypothyroidism you also may have less serotonin production and all the accompanying emotional and physiological problems related to that, like depression and minimized signaling that tells you to stop eating.
The cravings don’t go away, they intensify with weight gain and hypothyroidism. And this is all accompanied by emotional discomfort that makes you want to reach for that high carb comfort food.
Naturally, we can’t leave you there. Let’s talk about what to do about all of this.
In a simple sense the root of all of this can be summed up with one word: inflammation. Being overweight is a problem of inflammation. So is Hashimoto’s, the most common cause of hypothyroidism.
So the most important thing to do is to reduce inflammation. And if you do that you can start to unwind many of these hormonal and neurotransmitter disruptions that are leading you down the road to feeling really crappy a lot of the time.
One place to start is with some version of the Paleo diet. There are many versions, with my patients I use a version that is tailored for people with autoimmune disease.
This is also called the elimination diet and is very restrictive. But it is also very effective. Desperate times call for desperate measures.
If you want to unwind all of these vicious cycles and to reset leptin and insulin you can’t mess around and use half measures. When things get bad, half measures do not result in half results. They result in disappointment or worse, no results.
This diet involves the elimination of virtually everything that is inflammatory in your diet and it removes almost all of the carbohydrates that lead to most of the problems we have described, too.
This allows your body to convert from a sugar burning leptin and insulin resistant machine to a happy fat burning ecosystem. It also reduces systemic inflammation.
This is absolutely essential, but often, the diet is not enough. As we have seen here, many systems are involved (and this is just the tip of the iceberg).
Over time, these various systems start to break down because of the influence of thyroid hormone on virtually every aspect of our physiology -link. The impact of hypothyroidism is felt everywhere.
This can cause problems in all the other systems of your body including your adrenals, your liver, your heart, your pancreas, your brain, your blood and much more.
Other things to add to the mix are natural anti-inflammatories like Vitamin D, turmeric, glutathione and lots of fruits and vegetables high in anti-oxidants.
Also, it should be noted that the Paleo diet recommended here is not the all meat all the time variety.
It is a diet that consists of meat, and lots of vegetables, healthy fats like coconut oil, olive oil and fat from grass fed, organic animals and a healthy amount of fruit (featuring low glycemic varieties).
In addition, it is super important to eliminate from your diet other foods that are inflammatory like gluten, dairy products, soy, artificial sweeteners and processed foods.
The other important ingredient is exercise. If you have Hashimoto’s or hypothyroidism this can be a real challenge because many people don’t have the energy to do anything.
But it’s really important that you do and that you do it consistently and at a relatively high intensity. For some people you may only be able to do high intensity for a few minutes a few times a week. Here’s a post I did on this that discusses how to exercise with Hashimoto’s.
But gradually, as your lose the weight and the inflammation you will have more efficient energy reserves and distribution and you will turn this oppressive trend of downward spirals on its head and create a positive upward momentum towards weight loss and healing.
It can be done. It takes commitment and it takes perseverance. But, the results are well worth the effort.
http://www.ncbi.nlm.nih.gov/pubmed/20205113 – IL-6 and Hashimoto’s
http://www.ncbi.nlm.nih.gov/pubmed/21528812 – low vitamin D and insulin resistance
http://www.ncbi.nlm.nih.gov/pubmed/11356711 -NPY inhibits HPT axis
http://www.ncbi.nlm.nih.gov/pubmed/21914774 – leptin resistance and neuropeptide y
http://www.nature.com/mp/journal/v7/n2/full/4000963a.html – thyroid hormone and serotonin
http://thyroid.about.com/cs/dietweightloss/a/losingweight.htm
http://www.jackkruse.com/chapter-one-on-leptin/ – good discussion on leptin
http://endo.endojournals.org/content/138/10/4485.short – leptin and thyroid hormone
http://www.eje-online.org/content/149/4/257.full.pdf -leptin and thyroid dysfunction
http://www.ncbi.nlm.nih.gov/pubmed/18840640 -obesity in children and thyroid dysfucntion
http://www.ncbi.nlm.nih.gov/pubmed/18852923 – relationship between TSH and BMI
Hey people!
I was asked by a Turkish Hashimoto’s support group to answer some questions.
They had a lot of them (41 to be exact).
Many of these questions are universal and they will benefit you no matter where you live. And I also go into much more detail in my new book, Roadmap to Remission.
One thing this showed me was that Hashimoto’s knows no borders and the quality of care worldwide is pretty poor.
Yet another reason why we are here.
Please check it out and share it with anyone you think might benefit.
And if you don’t have a copy of my new book, what are you waiting for?
Here are some of the reviews that have been coming in:
“This is the definitive book on how YOU can get your Hashimotos into remission–and stay there. Although the book contains tons of information, it is surprisingly an easy, digestible read.
Something you can refer to again and again. It answered all of my many questions from both a conventional and alternative medical perspective. You can tell the author has been there, done that, and is willing to share the whole journey.
It’s like having a conversation with a compassionate, slightly quirky genius, who only wants you to feel better because he understands the nightmare you are going through. If you have Hashimotos, then this book will be the best investment you will ever make. You’ll save yourself from years of confusion, pain, suffering, financial drain, and ill health. What have you got to lose?” D
“If you, or anyone you love, is living with Hashimoto’s thyroiditis, this guide is a must have. There is so much wisdom packed into this book – I am happy I bought it, so that I can read it time and again. I also have had my highlighter out to notate the nuggets of wisdom that pop out of each section.
The other thing I love about it, is the tone of the writing. Marc Ryan has taken clinical information and made it accessible, all while making the whole thing somewhat funny. Not belittling the scenario with the humor, but sprinkling much appreciated levity over a sometimes too heavy subject. I found myself chuckling throughout the read.
I highly recommend reading this guide. The angle of Chinese medicine that is included is quite interesting, and different than any of the other thyroid books out there. You will not be disappointed.” Amanda Baker
“Rescue Remedy is what I call this book.Rescue from the myriad of medical practitioners that have poor knowledge base of Hashimoto’s Disease, rescue from tons of misinformation, rescue from believing there’s no hope and you must live the rest of your life feeling horrible.
Remedy because there’s a “potion” that will heal you if you are brave enough to try it. The information does take time to absorb, but that’s ok because review of concepts and ideas are right there at your finger tips.” Julie
Click the link above and get a copy for yourself. You just mind find hope, help and healing.
Micronutrients are important for proper thyroid function
Hypothyroidism affects nearly 10% of the US population. That’s upwards of 35 million people. And Hashimoto’s is believed to be the leading cause.
In actuality, hypothyroidism can be caused by many other factors, as well. And to complicate matters, both of these conditions can lead to the other.
Prolonged, chronic hypothyroidism can become Hashimoto’s and virtually everyone with Hashimoto’s becomes hypothyroid eventually because their thyroids are gradually destroyed by their immune system.
One common factor that we see with both patient populations is deficiencies of important micronutrients such as selenium, zinc, iron, Vitamin D, B Vitamins, Vitamin A and Vitamin E.
(Iodine is also an important nutrient that is sometimes deficient, but it is also quite controversial due to it’s ability to rapidly cause an increase in both TSH and antibody levels, and in some cases, increase in hypothyroid symptoms. People with Hashimoto’s, MUST, therefore be extra cautious hen supplementing with iodine. As a general rule you should test first, then, if you need to supplement, work with someone who knows what they are doing.)
In this 2 part post we will first explore some of the causes of nutrient deficiencies, and, then in part 2, best practices for supplementing and correcting them. And of course, as always, why it matters.
If you are a follower of our blog, you know that I’m always interested in why things happen, so before we look at the actual nutrients, let’s look at the most common causes of nutrient deficiencies in the body.
1. Low Stomach Acid
2. Leaky Gut or Intestinal Permeability
3. Soda Consumption
4. Tea and Coffee
5. MTHFR and VDR Gene Mutations
With Hashimoto’s and hypothyroidism, a very common problem is that too little gastrin and stomach acid (hydrochloric acid or HCL) are produced. This can result in a number of things that can lead to micronutrient deficiencies.
(For an in depth read on this problem, check out this post.
For example, one thing that HCL is important for is the absorption of vital nutrients like B12, iron, and calcium and for breaking down and absorbing protein.
Too little HCL can also lead to inflammation, lesions and infections in the intestines.
All of that leads to poor absorption of these nutrients and thyroid hormone, leading to a vicious cycle that leads to more hypothyroidism and more nutrient deficiencies.
It’s a positive feedback loop of repeated deficiencies making each other worse.
The following micronutrients depend on proper stomach acid levels in order to be absorbed in the small intestine:
Chromium
Copper
Iron
Magnesium
Manganese
Molybdenum
Selenium (selenite form is not pH dependent)
Zinc
B 12
And it’s also important to note that medication that reduces and/or eliminates acid reflux like proton pump inhibitors and antacids, may also cause poor absorption of these vitamins and minerals.
When the lining of the digestive tract is inflamed, the connections between the pieces of lining known as “tight junctions” break down and allow large, undigested compounds—toxins and bacteria—to leak into the bloodstream.
These substances all react with the intestine’s immune system and cause an exaggerated immune response. This over-reaction by the immune system becomes another vicious cycle that leads to more intestinal damage.
And as this problem grows, diet, lifestyle, medications, and infections can cause further intestinal inflammation that can ultimately lead to more serious problems.
In addition, after the intestinal lining becomes damaged, the damaged cells become unable to properly digest food and produce the enzymes necessary for digestion.
This damage can lead to micronutrient deficiencies, malnourishment, hypothyroidism and more autoimmune disease.
It’s another positive feedback loop perpetuating further damage and further deficiencies. This is a problem because so many things are absorbed in the gut, mostly through the small intestines.
For example:
Approximately 80% of water is absorbed by the small intestine, 10% by the large intestine and the remaining 10% excreted in the feces.
All of the important electrolytes are absorbed in the small intestine: chloride, iodine, calcium (these are absorbed with the help of vitamin D), iron, magnesium and potassium.
Vitamins including fat soluble ones (Vitamins A, D, E and K) are absorbed together with dietary fats.
Water soluble vitamins like vitamins B and C are absorbed by diffusion. Vitamin B12 combined with intrinsic factor (from the stomach) is absorbed by active transport.
Of these iron is absorbed in the duodenum, most are absorbed in the jejunum and Vitamin B12 and bile salts are absorbed in the later part of the ileum.
So you can see, when this process is damaged or impaired there are a lot of potential consequences.
There are several micronutrient deficiencies that a recent Brazilian review published in 2012 by Teixeira TF et al found to be associated with leaky gut and obesity, specifically vitamin A, magnesium, zinc, vitamin D, and calcium.
Vitamin A, zinc, and magnesium all help maintain tight junctions in the intestine and regulate endothelial cells in the gut, while vitamin D stimulates intestinal lining rebuilding and it can slow the damage by calming and regulating the immune system.
Vitamin D and calcium play a joint role in maintaining the protective barrier of the intestines by helping ATP (the cell’s energy source) mechanisms in the intestinal cells.
In obesity (which is found in some hypothyroid and Hashimoto’s patients), intake of these micronutrients is sometimes low, so deficiencies could play a major role in making leaky gut conditions worse, especially when combined with an unhealthy intestinal ecosystem and poor food choices.
What that all means is that having a good intake of these micronutrients could be protective against the development of leaky gut and the inflammation and eventual obesity it can cause.
Most popular sodas (like Coke, Pepsi, Dr. Pepper and Mountain Dew, etc.) are loaded with sugar, and caffeine and this mixture is suspended in phosphoric acid, which actually allows you digest it.
Here’s what happens in your body when you drink one of these drinks:
First, about 10 teaspoons of sugar hit your system (roughly 100% of what you’re supposed to consume in a day). This causes a massive spike in insulin and your liver freaks out and turns all of this excess sugar immediately into fat.
Then the caffeine kicks in and causes a massive burst of stress hormones to be released from the adrenals, which causes the liver to kick all that sugar into your bloodstream and causes a massive release of cortisol to try and deal with it.
This cortisol release also reduces stomach acid levels, impairs your immune response and, ultimately, causes your intestinal lining to be further compromised.
Sugar, caffeine and phosphoric acid all impair absorption of vital nutrients like iron, calcium and zinc. And the phosphoric acid actually binds to these minerals.
Then the diuretic properties of caffeine kick in and you pee all these valuable nutrients out.
This is pretty much the same as soda, minus the added problems caused by phosphoric acid.
Let’s take a look at how caffeine can lead to deficiencies in important micronutrients.
Calcium
As we discussed above, caffeine is a diuretic. It makes you pee. Caffeine causes calcium to be excreted in the urine and feces. According to “Effects of caffeine on health and nutrition: A Review” by Tsedeke Wolde, for every 150 mg of caffeine ingested, about the amount in one cup of coffee, an estimated 5 mg of calcium is lost.
Caffeine also inhibits the amount of calcium that is absorbed through the intestinal tract and depletes the amount retained by the bones. In fact, one study of postmenopausal women found that those who drank more than 300 mg of caffeine lost more bone in their spines than women who did not drink as much.
Vitamin D
Caffeine also inhibits vitamin D receptors, which means less may be absorbed. Because vitamin D is important in the absorption and use of calcium in building bone, this could also decrease bone mineral density, resulting in an increased risk for osteoporosis.
Iron
Caffeine interferes with the body’s absorption of iron (sugar does too), which is important for many processes in the body like red blood cell production, and carrying thyroid hormone to the cells.
Tea reduces iron absorption significantly more than coffee, but both impair absorption. Tannins in tea can also bind to iron, and prevent absorption of calcium and thyroid hormone, as well.
B Vitamins
Water soluble vitamins, such as the B-vitamins, can be depleted by the fluid loss caused by the diuretic effects of caffeine. In addition, it interferes with the metabolism of some B-vitamins, such as thiamine (vitamin B1).
Caffeine may also reduce the absorption of manganese, zinc and copper. It also increases the excretion of the minerals magnesium, potassium, sodium and phosphate. There is also evidence that caffeine interferes with the action of vitamin A.
Basically, what the MTHFR gene does is produce an enzyme with the same really long name (methylenetetrahydrofolate reductase).
Genes produce enzymes and these enzymes do all the heavy lifting, they do the work.
Without enzymes we wouldn’t have physiological function.
The job for the MTHFR enzyme is to convert one form of folate into the most active and usable form of folate in the human body – in every cell in the body. This type of folate is called methyltetrahydrofolate or more commonly by it’s nickname methylfolate.
Another really common finding that I see in analyzing blood test results from Hashimoto’s patients is that they have high levels of homocysteine.
As it turns out, low activity of the MTHFR enzyme may also lead to this. High homocysteine is a major risk factor for heart disease, inflammation, difficult pregnancies, birth defects, and more.
Nutrient deficiencies in Folate B6, and B12 have been linked to high homocysteine.
To matters more complicated, people with MTHFR issues may have a difficult time processing certain types of folic acid like those found in processed food and cheap supplements.
VDR gene defects can lead to poor absorption and utilization of vitamin D in the body, which can lead to a more active immune system, worse symptoms and a faster progression of Hashimoto’s and hypothyroidism.
You see, more positive feedback loops resulting in more vicious cycles reinforcing an existing problem.
The big takeaway here is that all the factors mentioned in this article can lead to positive feedback loops or repeated problems that make each other worse. So if you have low stomach acid, leaky gut and you drink sodas, coffee and tea, you may be, unwittingly, causing your own health to decline.
And in this situation, taking supplements containing these vitamins and minerals may not do much good if you don’t address the root causes of the problems (like the low stomach acid and leaky gut) and start working on reducing the positive feedback loops that lead to this in the first place.
Because here’s the thing, these positive feedback loops can be reversed and you can achieve positive healing momentum if you get to the bottom of this and correct the underlying imbalances. I write all about how to do this in my new book, Roadmap to Remission.
In part 2 of this post, we’ll explore these micronutrients and look at best practices for correcting the causes of deficiencies and for supplementing them with food and supplements.
http://www.ncbi.nlm.nih.gov/pubmed/18341376 -Coffee interferes with T4 absorption
Benvenga, S. et. al. “Altered Intestinal Absorption of L-Thyroxine Caused by Coffee.” Thyroid. Volume 18 Issue 3, pages 293-301. March 2008 Abstract.
Mazzaferri, MD MACP, Ernest. “Thyroid Hormone Therapy,” Clinical Thyroidology for Patients: Summaries for Patients from Clinical Thyroidology. August 2008 Vol 1, Iss 1.
Sindoni, Alessandro et. al. “Case Report: Coffee Impairs intestinal Absorption of Levothyroxine: Report of Additional Cases,” Hot Thyroidology, Article 5/09
http://www.ncbi.nlm.nih.gov/pubmed/23039890 – Severity of Hashimoto’s corresponds with genetic defect
http://www.ncbi.nlm.nih.gov/pubmed/17669709 Effect of proton pump inhibitors on absorption of levothyroxine
http://link.springer.com/article/10.1007/BF01297127
http://www.ncbi.nlm.nih.gov/pubmed/23084636 Obesity and nutrient deficiencies linked to leaky gut
http://www.appliedneuroscience.com.au/resources/Documents/NN%20156%20intes%20permeab%20malabsorb.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084394/ -Intestinal crosstalk, very interesting article on how this is all connected
http://www.ncbi.nlm.nih.gov/pubmed/7599455 caffeine and calcium
http://www.ncbi.nlm.nih.gov/pubmed/1564564 calcium, coffee and oesteoporisis
http://www.ncbi.nlm.nih.gov/pubmed/16758142 Swedish cohort on oesteoporosis and caffeine
http://www.ncbi.nlm.nih.gov/pubmed/6402915 inhibition of food iron by coffee
http://www.ncbi.nlm.nih.gov/pubmed/6896705 Effects of various drinks on iron absorption
Effects of caffeine on health and nutrition: A Review, Tsedeke Wolde Lecturer of Nutrition, Department of Public Health, College of Medical and Health Sciences, Wollega University, Nekemte, Ethiopia
The Thyroid, A Fundamental and Clinical Text, Ninth Edition. Lewis E. Braverman and Robert D. Utiger 2005
http://hypothyroidmom.com/11-ways-coffee-can-impact-your-thyroid/