Thyroid Dysfunction.ppt


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Thyroid Dysfunction.ppt

  2. 2. <ul><li>MÜKAM KARÔTI VACÁLAM </li></ul><ul><li>PANGUM LANGHAYATÄ GIRIM </li></ul><ul><li>YATKRIPÁ TAMAHAM VANDÄ </li></ul><ul><li>PARAMÁNANDA SÁGARAM </li></ul>PRAYER
  3. 3. <ul><li>Name of the disease & terminologies </li></ul><ul><li>Etiology </li></ul><ul><li>Physical examination, signs and symptoms </li></ul><ul><li>Investigation </li></ul><ul><li>Modern medical treatment </li></ul><ul><li>Alternative therapies – Yoga management </li></ul><ul><li>Books and journals for reference </li></ul>
  4. 4. The thyroid gland is located at the base of the neck, just below the Adam's apple.
  5. 5. INTRODUCTION <ul><li>The thyroid is a butterfly-shaped gland located at the base of the neck, just below the Adam's apple. </li></ul><ul><li>Weighing less than an ounce, the thyroid gland produces hormones that regulate every aspect of metabolism, from heart rate to how quickly the patient burn calories. </li></ul><ul><li>Sometimes normal thyroid tissue begins to grow, causing one or more nodules to develop within the gland. </li></ul>
  6. 6. <ul><li>The great majority of these solid or fluid-filled lumps are noncancerous (benign) and don't cause any symptoms. </li></ul><ul><li>In fact, patient often won't know they have a nodule until the doctor discovers it during a routine medical exam. </li></ul><ul><li>Some nodules may become large enough to press on the windpipe or the esophagus, making it uncomfortable or difficult to swallow. </li></ul><ul><li>About 5 percent of nodules may be cancerous (malignant). </li></ul>
  7. 7. <ul><li>Treatment depends on the type of nodule they have. </li></ul><ul><li>Resembling a shield; denoting a gland (thyroid gland) and a cartilage of the larynx (thyroid cartilage) having such a shape. </li></ul><ul><li>The cleaned, dried, and powdered thyroid gland obtained from one of the domesticated animals used for food and containing 0.17 to 0.23% of iodine; used in the treatment of hypothyroidism, cretinism and myxedema, in certain cases of obesity, and in skin disorders. </li></ul>
  8. 8. Thyroid diseases can be broadly divided into the following categories: <ul><li>Overproduction of thyroid hormone (hyperthyroidism) </li></ul><ul><li>Underproduction of thyroid hormone (hypothyroidism) </li></ul><ul><li>Benign (noncancerous) thyroid disease </li></ul><ul><li>Thyroid cancer </li></ul>
  9. 9. TYPES OF THYROID DISEASE <ul><li>Anaplastic carcinoma of the thyroid </li></ul><ul><li>Chronic thyroiditis (Hashimoto's disease) </li></ul><ul><li>Colloid nodular goiter </li></ul><ul><li>Hyperthyroidism </li></ul><ul><li>Hypopituitarism </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Hypothyroidism – primary/secondary </li></ul><ul><li>Medullary thyroid carcinoma </li></ul><ul><li>Painless (silent) thyroiditis </li></ul><ul><li>Papillary carcinoma of the thyroid </li></ul><ul><li>Subacute thyroiditis </li></ul><ul><li>Thyroid cancer </li></ul><ul><li>Congenital goiter </li></ul>
  10. 10. SIGNS & SYMPTOMS <ul><li>Most thyroid nodules don't cause signs or symptoms. </li></ul><ul><li>Occasionally some may become so large that they can feel or even see the swelling at the base of the neck, especially when shaving or putting on makeup. </li></ul><ul><li>Men sometimes become aware of a nodule because their shirt collars suddenly feel too tight. </li></ul><ul><li>Some nodules produce too much thyroxine, a hormone secreted by the thyroid gland. </li></ul>
  11. 11. The extra thyroxine can cause signs and symptoms such as: <ul><li>Sudden, unexplained weight loss </li></ul><ul><li>Nervousness </li></ul><ul><li>Rapid or irregular heartbeat. </li></ul>Although thyroid nodules are seldom cancerous, a nodule is more likely to be malignant if it: <ul><li>Grows quickly or feels hard </li></ul><ul><li>Causes – to become hoarse or to have trouble swallowing or breathing </li></ul><ul><li>Causes enlarged lymph nodes under the jaw or in the neck. </li></ul>
  12. 12. COMMON SYMPTOMS OF HYPERTHYROIDISM <ul><li>Palpitations </li></ul><ul><li>Heat intolerance </li></ul><ul><li>Nervousness </li></ul><ul><li>Insomnia </li></ul><ul><li>Breathlessness </li></ul><ul><li>Increased bowel movements </li></ul><ul><li>Light or absent menstrual periods </li></ul><ul><li>Fatigue </li></ul><ul><li>Fast heart rate </li></ul><ul><li>Trembling hands </li></ul><ul><li>Weight loss </li></ul><ul><li>Muscle weakness </li></ul><ul><li>Warm moist skin </li></ul><ul><li>Hair loss </li></ul><ul><li>Staring gaze </li></ul>
  13. 13. SYMPTOMS OF HYPOTHYROIDISM <ul><li>Allergies (developing or worsening) </li></ul><ul><li>Anxiety </li></ul><ul><li>Breathing difficulties (shortness of breath, chest tightness) </li></ul><ul><li>Cold body temperature (feeling cold ) </li></ul><ul><li>Constipation </li></ul><ul><li>Depression </li></ul><ul><li>Dizziness </li></ul><ul><li>Facial puffiness </li></ul><ul><li>Fatigue </li></ul><ul><li>Fertility problems (miscarriage too) </li></ul>
  14. 14. <ul><li>Eye problems (bulging eyes; gritty, dry, achy, blurry, irritated, red eyes; light sensitivity; double vision; jumpy eyes) </li></ul><ul><li>Goiter </li></ul><ul><li>Hair problems (coarse, dry texture) </li></ul><ul><li>Hearing disabilities (tinnitus, ear ringing) </li></ul><ul><li>High cholesterol levels </li></ul><ul><li>Infections (less resistance) </li></ul><ul><li>Low blood pressure </li></ul><ul><li>Menstrual changes (flow, duration) </li></ul><ul><li>Mental Challenges (brain fog, lack of focus, concentration) </li></ul>
  15. 15. <ul><li>Mood changes </li></ul><ul><li>Muscle and joint aches (especially hands and feet) </li></ul><ul><li>Nail problems (dry, brittle) </li></ul><ul><li>Sexual dysfunction (low drive, impotence in men) </li></ul><ul><li>Skin changes (dry, itchy, patchy) </li></ul><ul><li>Sleep apnea ,and snoring </li></ul><ul><li>Slow pulse </li></ul><ul><li>Throat problems </li></ul><ul><li>Voice changes (hoarse, husky) </li></ul><ul><li>Weakness (overall, all the time) </li></ul><ul><li>Weight fluctuation (gain or loss) </li></ul>
  16. 16. CAUSES <ul><li>Thyroid gland consists of two lobes that resemble the wings of a butterfly. </li></ul><ul><li>The lobes are separated by a thin section — think of it as the butterfly's body — called the isthmus. </li></ul><ul><li>The thyroid takes up iodine from food they eat and uses it to manufacture two main hormones, thyroxine (T-4) and triiodothyronine (T-3). </li></ul>
  17. 17. <ul><li>These hormones maintain the rate at which the body uses fats and carbohydrates, help control the body temperature, influence the heart rate and help regulate the production of protein. </li></ul><ul><li>Thyroid gland also produces calcitonin, a hormone that regulates the amount of calcium in the blood. </li></ul><ul><li>Just why normal thyroid tissue develops into nodules isn't clear. </li></ul>
  18. 18. What is known is that several types of nodules can develop in the thyroid gland: <ul><li>Colloid nodule. </li></ul><ul><li>Follicular adenoma. </li></ul><ul><li>Thyroid cyst. </li></ul><ul><li>Inflammatory nodule. </li></ul><ul><li>Thyroid cancer. </li></ul><ul><li>Multinodular goiter. </li></ul><ul><li>Hyperfunctioning thyroid nodule (toxic adenoma, toxic multinodular goiter, Plummer's disease). </li></ul>
  19. 19. COLLOID NODULE <ul><li>Most thyroid nodules are colloid nodules — benign overgrowths of normal thyroid tissue. </li></ul><ul><li>The patient may have just one colloid nodule or many. </li></ul><ul><li>Although these nodules may grow larger, they don't spread beyond the thyroid gland. </li></ul>FOLLICULAR ADENOMA <ul><li>This type of nodule also is benign. </li></ul>
  20. 20. THYROID CYST <ul><li>These fluid-filled areas of the thyroid can range in size from less than 1/3 inch in diameter to one inch or more. </li></ul><ul><li>Many thyroid cysts are entirely filled with fluid, but some cysts, called complex cysts, also have solid components. </li></ul><ul><li>Fluid-filled cysts are usually benign, but complex cysts are sometimes malignant. </li></ul>
  21. 21. INFLAMMATORY NODULE <ul><li>This occasionally develops as a result of chronic inflammation of the thyroid gland (thyroiditis). </li></ul><ul><li>One rare type of thyroiditis — subacute thyroiditis — causes severe pain in the thyroid gland. </li></ul><ul><li>Other types are painless and sometimes occur after pregnancy (postpartum thyroiditis). </li></ul>
  22. 22. THYROID CANCER <ul><li>The chances that a nodule will be malignant are small, the patient’s are at higher risk if they have a family history of thyroid or other endocrine cancers, are younger than 20 or older than 60, are a man, or have a history of head or neck radiation. </li></ul><ul><li>Malignant nodules are usually large and hard and may cause neck discomfort or pain. </li></ul>
  23. 23. MULTINODULAR GOITER <ul><li>Goiter is a term used to describe any enlargement of the thyroid gland. </li></ul><ul><li>Several factors can lead to a goiter, including the presence of a number of thyroid nodules. </li></ul><ul><li>This condition, called multinodular goiter, can cause a tight feeling in the throat and difficulty breathing or swallowing. </li></ul>
  24. 24. HYPERFUNCTIONING THYROID NODULE <ul><li>Toxic adenoma, toxic multinodular goiter, Plummer's disease </li></ul><ul><li>These nodules grow and produce thyroid hormones independent of the influence of thyroid-stimulating hormone (TSH), a substance released by the pituitary gland, which normally regulates the production of thyroid hormones. </li></ul><ul><li>Hyperfunctioning thyroid nodules cause high blood levels of thyroxine and low or nonexistent levels of TSH. </li></ul><ul><li>A genetic defect of the TSH receptors may play a role in the overactivity of these nodules. </li></ul>
  25. 25. RISK FACTORS <ul><li>Heredity . If a parent or sibling has thyroid nodules, there is a greater chance of developing them as well. </li></ul><ul><li>Age . Because the likelihood of developing thyroid nodules increases as grow older, some changes in thyroid tissue may occur as a normal part of aging. </li></ul><ul><li>Sex . Women are more likely to develop thyroid nodules than men are. </li></ul><ul><li>Certain thyroid conditions . Nodules are more likely to form in people who have or have had thyroiditis — a chronic inflammation of the thyroid gland. </li></ul>
  26. 26. RADIATION EXPOSURE <ul><li>In the 1940s and 1950s, children, teenagers and even newborns were often treated with radiation for benign conditions such as acne or enlarged tonsils. </li></ul><ul><li>If the patient once had radiation therapy to the neck or head for conditions such as acne, they have an increased risk of developing thyroid nodules. </li></ul><ul><li>They are also at increased risk if they were exposed to radioactive particles released into the air during atomic weapons testing or in nuclear power plant accidents, such as the 1986 Chernobyl disaster in the former Soviet Union. </li></ul><ul><li>Radiation not only affects people, animals and crops in the immediate vicinity of the release but also can affect areas thousands of miles away. </li></ul>
  27. 27. WHEN TO SEEK MEDICAL ADVICE <ul><li>See the doctor if the patient notice any unusual swelling in the lower front of the neck, if they have trouble breathing or swallowing, or feel a lump in the throat. </li></ul><ul><li>Also seek medical care if develops signs and symptoms of hyperthyroidism, such as: </li></ul><ul><ul><li>Sudden weight loss even though the appetite is normal or has increased </li></ul></ul><ul><ul><li>A pounding heart </li></ul></ul><ul><ul><li>Trouble sleeping </li></ul></ul><ul><ul><li>Muscle weakness </li></ul></ul><ul><ul><li>Nervousness or irritability </li></ul></ul>
  28. 28. <ul><li>It's important to completely describe the changes that observed, because many signs and symptoms of hyperthyroidism may be associated with a number of other conditions. </li></ul>
  29. 29. SCREENING AND DIAGNOSIS <ul><li>Although sometimes may see or feel a thyroid nodule – usually just below and to the right or left of Adam's apple – most are discovered when the doctor checks the neck during a routine medical exam. </li></ul><ul><li>Patient will likely be asked to swallow while the doctor examines the thyroid because a nodule in the thyroid gland will usually move up and down during swallowing, whereas a nodule that forms in other parts of the neck won't. </li></ul>
  30. 30. <ul><li>Sometimes a thyroid nodule is detected when they have an imaging test such as an ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI) to evaluate another condition in the head or neck. </li></ul><ul><li>Nodules detected this way are usually smaller than those found during a physical exam. </li></ul>
  31. 31. Tests following discovery <ul><li>Once a nodule is discovered, it's important to determine whether it's malignant or associated with thyroid dysfunction. </li></ul><ul><li>For that reason, patient’s are likely to have one or more of the following tests: </li></ul><ul><li>Thyroid function tests </li></ul><ul><li>Fine-needle aspiration biopsy </li></ul><ul><li>Ultrasonography </li></ul><ul><li>Thyroid scan </li></ul>
  32. 32. THYROID FUNCTION TESTS <ul><li>Thyroid gland produces two main hormones, thyroxine and triiodothyronine. </li></ul><ul><li>The rate at which these hormones are released is part of a carefully controlled feedback system involving the thyroid gland, the pituitary gland and the hypothalamus – an area at the base of the brain that acts as a thermostat for this system. </li></ul><ul><li>Here's how the process works: The hypothalamus signals the pituitary gland to make thyroid-stimulating hormone (TSH). </li></ul>
  33. 33. <ul><li>Pituitary gland then releases TSH — the amount depends on how much thyroxine and triiodothyronine are in the blood. </li></ul><ul><li>Finally, thyroid gland regulates its production of hormones based on the amount of TSH it receives. </li></ul><ul><li>Tests that measure blood levels of thyroxine, triiodothyronine and TSH can indicate whether the thyroid is producing too much thyroxine (hyperthyroidism) or too little (hypothyroidism). </li></ul><ul><li>Although not definitive, this information is helpful because thyroid nodules are more often benign when blood levels of thyroid hormone are abnormal. </li></ul>
  34. 34. Fine-needle aspiration biopsy <ul><li>This test is the most sensitive for distinguishing between benign and malignant thyroid nodules. </li></ul><ul><li>During the procedure, the doctor inserts a thin needle – much smaller than the needles used to draw blood – in the nodule and removes a sample of cells. </li></ul><ul><li>The procedure, which is carried out in the doctor's office, takes about 20 minutes and has few risks. </li></ul><ul><li>The doctor is likely to take several samples from a single nodule. </li></ul>
  35. 35. <ul><li>If more than one nodule, the doctor will usually take samples from these as well. </li></ul><ul><li>Sometimes, especially in the case of complex cysts, the doctor may use ultrasound to help guide the placement of the needle. </li></ul><ul><li>The samples are then sent to a laboratory and analyzed under a microscope. </li></ul><ul><li>Most nodules diagnosed using FNA biopsy are benign. </li></ul><ul><li>These nodules may grow, but they aren't cancerous and won't spread beyond the thyroid gland. </li></ul>
  36. 36. <ul><li>A small percentage of biopsied nodules are malignant. </li></ul><ul><li>This diagnosis is based on the characteristics of individual cells and patterns in clusters of cells that are different from normal thyroid tissue. </li></ul><ul><li>In some cases, a pathologist can determine specific types of cancer from an FNA biopsy sample. </li></ul><ul><li>Sometimes there may not be enough cells in a sample to accurately determine whether a nodule is benign or malignant. </li></ul>
  37. 37. <ul><li>In that case, the patient likely to have the test repeated. </li></ul><ul><li>And in some FNA biopsies, the test results are considered suspicious or indeterminate, which means there's no definitive way to tell from the biopsy sample whether the nodule is cancerous. </li></ul><ul><li>Repeat biopsies usually aren't helpful in suspicious cases, so the next step is often surgery to remove the nodule for a definitive diagnosis. </li></ul>
  38. 38. Ultrasonography <ul><li>This imaging technique uses high-frequency sound waves rather than radiation to produce images. </li></ul><ul><li>It may be used to distinguish cysts from solid nodules and to guide doctor in performing an FNA biopsy. </li></ul>
  39. 39. Thyroid scan <ul><li>Sometimes patient may have a thyroid scan to help evaluate thyroid nodules. </li></ul><ul><li>During this test, an isotope of radioactive iodine is injected into the vein on the inside of the elbow. </li></ul><ul><li>Patient then lie on a table while a special camera produces an image of thyroid on a computer screen. </li></ul><ul><li>Nodules that produce excess thyroid hormone – called &quot;hot&quot; nodules – show up on the scan because they take up more of the isotope than normal thyroid tissue does. </li></ul>
  40. 40. <ul><li>&quot;Warm&quot; nodules look and function like normal tissue, while &quot;cold&quot; nodules are nonfunctioning and appear as defects or holes in the scan. </li></ul><ul><li>Hot nodules are almost always benign, but a small percentage of warm or cold nodules are malignant. </li></ul><ul><li>The disadvantage of a thyroid scan is that it can't distinguish between benign and malignant warm and cold nodules. </li></ul><ul><li>The length of a thyroid scan varies, depending on how long it takes the isotope to reach thyroid gland. </li></ul><ul><li>Patient may have some neck discomfort because neck is stretched back during the scan, and will be exposed to a small amount of radiation. </li></ul>
  41. 41. COMPLICATIONS <ul><li>Although most thyroid nodules are benign, they sometimes can cause serious complications. </li></ul><ul><li>Large nodules or a multinodular goiter can interfere with swallowing or breathing. </li></ul><ul><li>More serious problems occur when a nodule or goiter produces thyroid hormone, leading to hyperthyroidism. </li></ul><ul><li>In addition to signs and symptoms such as unintended weight loss, muscle weakness, heat intolerance and anxiousness or irritability, hyperthyroidism can also cause the following: </li></ul>
  42. 42. <ul><li>Heart-related complications . These include a rapid heart rate, atrial fibrillation and congestive heart failure – a condition in which the heart becomes too weak to circulate enough blood to meet the needs of the body. </li></ul><ul><li>Thyrotoxic crisis . This is a sudden and potentially life-threatening intensification of the symptoms that requires immediate medical care. </li></ul>
  43. 43. <ul><li>Weak, brittle bones (osteoporosis). The strength of bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with the body's ability to incorporate calcium into the bones. In fact, hyperthyroidism often affects the bones before any other signs or symptoms of the disorder. This is especially true of postmenopausal women who are already at high risk of osteoporosis. </li></ul>
  44. 44. TREATMENT <ul><li>Working together with doctor can determine the best treatment. </li></ul><ul><li>Depending on the type of thyroid nodule the options may include: </li></ul><ul><li>Watchful waiting. </li></ul><ul><li>Thyroid hormone suppression therapy. </li></ul><ul><li>Radioactive iodine. </li></ul><ul><li>Alcohol ablation. </li></ul><ul><li>Surgery </li></ul>
  45. 45. SURGERY <ul><li>The usual treatment for malignant nodules is surgical removal, often along with the majority of thyroid tissue – procedure called near-total thyroidectomy. </li></ul><ul><li>Occasionally, a nodule that's clearly benign may require surgery, especially if it's so large that it makes it hard to breathe or swallow. </li></ul><ul><li>Surgery is also considered the best option for people with large multinodular goiters, particularly when the goiters constrict airways, the esophagus or blood vessels. </li></ul>
  46. 46. <ul><li>Nodules diagnosed as indeterminate or suspicious by FNA biopsy also must be surgically removed so that they can be examined more thoroughly for signs of cancer. </li></ul><ul><li>Risks of thyroid surgery include damage to the nerve that controls the vocal cords and damage to the parathyroid glands – four tiny glands located on the back of thyroid gland that help control the level of calcium in the blood. </li></ul><ul><li>After thyroidectomy, patient needs lifelong treatment with levothyroxine to supply the body with normal amounts of thyroid hormone. </li></ul>
  47. 47. NATURAL THYROID HEALTH RECOMMENDATIONS <ul><li>Avoid fluoride (including that found in toothpaste and water) an chlorine (also found in tap water). Chlorine, fluoride and iodine are chemically related. Chlorine and fluoride block iodine receptors in the thyroid gland, resulting in reduced iodine reducing hormone production and finally hypothyroidism. Use a fluoride free toothpaste. </li></ul><ul><li>Avoid stimulants such as caffeine and alcohol. These upset the glandular system resulting in further imbalance. </li></ul>
  48. 48. <ul><li>Eat a whole food diet that consists of 75% raw fruits and vegetables. With whole grains, seeds, nuts, brown rice, legumes and millet. Patient may include natural whole food supplements but must eat as well! There are some foods that hypothyroid patients should avoid or eat in moderation. Members of the cabbage family (cabbage, kale, broccoli, cauliflower) suppress thyroid function, and should be eaten in moderation. The best cooking oils for people with hypothyroid are sunflower, olive, and sesame. Avoid canola, corn, soybean and rapeseed. </li></ul>
  49. 49. <ul><li>Avoid &quot;low energy foods&quot; such as sugar, fried foods, saturated fats, meat, alcohol, caffeine and processed foods. Try a natural acid alkaline program or detoxification supplement. </li></ul><ul><li>Use a natural thyroid supplement with herbs that support thyroid function and nutrition. Thyroid Help is not a drug, medication or hormone, it is a natural dietary supplement. </li></ul>
  50. 50. <ul><li>Ayurveda </li></ul><ul><li>Naturopathy </li></ul><ul><li>Homeopathy </li></ul><ul><li>Qi-gong </li></ul><ul><li>Reiki </li></ul><ul><li>Acupuncture </li></ul><ul><li>Cognitive therapy </li></ul><ul><li>Hypnotherapy </li></ul>ALTERNATIVE THERAPIES
  51. 51. YOGA PRACTICES <ul><li>YOGA IS BALANCE (SAMATVAM) </li></ul><ul><li>I A Y T CORRECTS IMBALANCES </li></ul><ul><li>AIMS : </li></ul><ul><li>STRESS REDUCTION </li></ul><ul><li>RELIEF OF PAIN </li></ul><ul><li>MEDICATION REDUCTION </li></ul>
  52. 52. Ánandamaya Kôùa Vijòanánmaya Kôùa PERFECT HEALTH Manômaya Kôùa Annamaya Kosa Pranamaya Kosa ÁDHIJA VYÁDHIS YOGA Panchakosa concept
  53. 53. INTEGRATED YOGA MODULE FOR THYROID DYSFUNCTION <ul><li>Loosening and breathing exercises </li></ul><ul><li>Loosening of fingers </li></ul><ul><li>Loosening of wrists </li></ul><ul><li>Rotation of shoulder </li></ul><ul><li>Neck bending </li></ul><ul><li>Neck rotation </li></ul><ul><li>Pada sancalana </li></ul><ul><li>Hand stretch breathing </li></ul><ul><li>Tiger breathing </li></ul><ul><li>Sasankasana breathing </li></ul><ul><li>Head rolling </li></ul><ul><li>Suryanamaskara </li></ul><ul><li>Quick relaxation technique (QRT) </li></ul>
  54. 54. <ul><li>Yogasanas </li></ul><ul><li>Ardhakaticakrasana </li></ul><ul><li>Padahastasana </li></ul><ul><li>Trikonasana </li></ul><ul><li>Vakrasana/ Ardha-Matsyendrasana </li></ul><ul><li>Ustrasana </li></ul><ul><li>Bhujangasana </li></ul><ul><li>Salabhasana </li></ul><ul><li>Deep relaxation technique (DRT) </li></ul>
  55. 55. <ul><li>Pranayama </li></ul><ul><li>Kapalabhati </li></ul><ul><li>Vibhaga pranayama </li></ul><ul><li>Candra Anuloma pranayama </li></ul><ul><li>Nadi suddhi </li></ul><ul><li>Sitali/ Sitkari/ Sadanta </li></ul><ul><li>Bhramari </li></ul><ul><li>Meditation (Dhyana Dharana) </li></ul><ul><li>Nadanusandhana </li></ul><ul><li>OM meditation </li></ul><ul><li>Kriyas </li></ul><ul><li>Jala Neti </li></ul><ul><li>Sutra Neti </li></ul><ul><li>Vamana Dhouti </li></ul>
  56. 56. SPECIFIC PRACTICES <ul><li>Pranayama </li></ul><ul><li>Naukasana </li></ul><ul><li>Uttanapadasana </li></ul><ul><li>Matsyasana </li></ul><ul><li>Sarvangasana </li></ul><ul><li>Yashtikasana </li></ul>
  57. 57. THANK YOU