thyroid disorders AND treatment

2025 advances thyroid disorders treatment thyroid eye disease radiofrequency ablation official guidelines

thyroid gland anatomy diagram and thyroid nodules ultrasound thyroid disorders

thyroid cancer AND targeted therapy

American Thyroid Association 2025 differentiated thyroid cancer guideline treatment advances thyroid eye disease teprotumumab

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mkdir -p "/tmp/workspace/thyroid-presentation/src" "/tmp/workspace/thyroid-presentation/output" "/tmp/workspace/thyroid-presentation/assets" && python /tmp/skills/shared/scripts/fetch_images.py "https://cdn.orris.care/cdss_images/2d5b7120530c0533ebeebe208a31c3bbe1414630ec3525d0baaaf348c9dc3560.png" > "/tmp/workspace/thyroid-presentation/assets/image_data.json"

python -c "import json,base64; from pathlib import Path; d=json.load(open('/tmp/workspace/thyroid-presentation/assets/image_data.json')); x=d[0]; Path('/tmp/workspace/thyroid-presentation/assets/tirads.png').write_bytes(base64.b64decode(x['base64'].split(',',1)[1])) if x.get('base64') else print(x)"

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/thyroid-presentation/src/create_deck.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE from pptx.enum.shapes import MSO_CONNECTOR OUT='/tmp/workspace/thyroid-presentation/output/Thyroid_Disorders_and_Treatment_Advances.pptx' IMG='/tmp/workspace/thyroid-presentation/assets/tirads.png' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] NAVY=RGBColor(13,35,59); TEAL=RGBColor(0,137,143); MINT=RGBColor(196,231,222); SKY=RGBColor(226,243,247); GOLD=RGBColor(244,184,66); RED=RGBColor(203,74,86); WHITE=RGBColor(255,255,255); INK=RGBColor(34,48,61); GRAY=RGBColor(92,106,119); PALE=RGBColor(246,249,250) def rect(s,x,y,w,h,fill,rad=False,line=None): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if rad else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h)); sh.fill.solid(); sh.fill.fore_color.rgb=fill; sh.line.color.rgb=line or fill; return sh def txt(s,x,y,w,h,text,size=18,color=INK,bold=False,align=PP_ALIGN.LEFT,font='Aptos',val=None): box=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=box.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(.04); tf.margin_top=tf.margin_bottom=Inches(.02); tf.vertical_anchor=val or MSO_ANCHOR.TOP for i,line in enumerate(text.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line; p.alignment=align; p.space_after=Pt(3) for r in p.runs: r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return box def title(s,number,heading,kicker='THYROID DISORDERS & TREATMENT ADVANCES'): rect(s,0,0,13.333,.25,TEAL); txt(s,.58,.45,10.9,.27,kicker,10,TEAL,True); txt(s,.58,.78,11.9,.6,heading,30,NAVY,True); txt(s,12.05,.48,.65,.28,f'{number:02d}',12,GRAY,True,align=PP_ALIGN.RIGHT) def footer(s,source=''): rect(s,.58,7.08,12.15,.012,RGBColor(210,220,224)); txt(s,.58,7.15,11.7,.18,source,7,GRAY); txt(s,12.0,7.14,.65,.18,'2026',7,GRAY,align=PP_ALIGN.RIGHT) def bullet(s,x,y,w,items,size=18): for i,a in enumerate(items): txt(s,x,y+i*.58,w,.45,'• '+a,size,INK) def pill(s,x,y,w,label,color=TEAL): rect(s,x,y,w,.34,color,True); txt(s,x,y+.055,w,.18,label,10,WHITE,True,align=PP_ALIGN.CENTER) def card(s,x,y,w,h,heading,body,accent=TEAL): rect(s,x,y,w,h,WHITE,True,RGBColor(223,230,232)); rect(s,x,y,.08,h,accent); txt(s,x+.25,y+.22,w-.45,.30,heading,16,NAVY,True); txt(s,x+.25,y+.64,w-.45,h-.78,body,12,GRAY) # 1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,0,0,13.333,.22,TEAL); rect(s,8.8,0,4.53,7.5,RGBColor(18,55,80)); txt(s,.72,.75,6.7,.32,'ENDOCRINOLOGY UPDATE',12,MINT,True); txt(s,.72,1.27,7.25,1.55,'Thyroid Disorders\nand Treatment Advances',35,WHITE,True); txt(s,.75,3.18,6.6,.6,'From hormone replacement to targeted and minimally invasive care',19,RGBColor(213,230,236)); # thyroid-like icon s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(9.45),Inches(2.18),Inches(1.25),Inches(1.55)).fill.solid(); s.shapes[-1].fill.fore_color.rgb=TEAL; s.shapes[-1].line.color.rgb=TEAL s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(10.92),Inches(2.18),Inches(1.25),Inches(1.55)).fill.solid(); s.shapes[-1].fill.fore_color.rgb=TEAL; s.shapes[-1].line.color.rgb=TEAL rect(s,10.48,2.8,.68,.30,TEAL,True); txt(s,9.4,4.35,3.85,.5,'Precision diagnosis • tailored therapy • survivorship',14,MINT,False,align=PP_ALIGN.CENTER) txt(s,.75,6.6,7.0,.3,'Prepared for academic presentation | September 2026',11,RGBColor(180,205,215)); # 2 s=prs.slides.add_slide(blank); title(s,2,'Why thyroid disease matters') card(s,.65,1.65,3.75,3.9,'Metabolic control','Thyroid hormone regulates energy use, thermogenesis, cardiac function, growth and neurodevelopment.',TEAL) card(s,4.78,1.65,3.75,3.9,'Broad clinical spectrum','Hypothyroidism, thyrotoxicosis, autoimmune disease, nodules, eye disease and malignancy demand distinct pathways.',GOLD) card(s,8.91,1.65,3.75,3.9,'A changing treatment model','Care is moving from one-size-fits-all treatment toward risk stratification, molecular testing and minimally invasive options.',RED) pill(s,.8,5.95,2.5,'Diagnosis'); pill(s,3.65,5.95,2.5,'Risk assessment',GOLD); pill(s,6.5,5.95,2.5,'Shared decisions',RED); pill(s,9.35,5.95,2.5,'Long-term follow-up',NAVY) footer(s,'Clinical overview based on Goldman-Cecil Medicine, Thyroid chapter; ATA resources.') # 3 s=prs.slides.add_slide(blank); title(s,3,'Core thyroid disorders at a glance') rows=[('Hypothyroidism','Usually Hashimoto disease, post-treatment or drug-related','Fatigue, cold intolerance, weight gain','Levothyroxine; assess adherence, interactions and target TSH',TEAL),('Hyperthyroidism','Graves disease, toxic nodules or thyroiditis','Palpitations, tremor, heat intolerance, weight loss','Beta-blockade plus antithyroid drugs, radioiodine or surgery',GOLD),('Nodules / goiter','Common; malignancy risk is usually low','Mass effect or incidental imaging finding','Ultrasound risk stratification, FNA when indicated, surveillance or intervention',RED),('Thyroid cancer','Mostly differentiated thyroid carcinoma','Nodule, nodal disease or incidental diagnosis','Risk-adapted surgery, selective radioactive iodine and surveillance',NAVY)] for i,(a,b,c,d,col) in enumerate(rows): y=1.5+i*1.25; rect(s,.65,y,12.0,1.02,WHITE,True,RGBColor(224,231,233)); rect(s,.65,y,.12,1.02,col); txt(s,.92,y+.16,2.05,.25,a,15,NAVY,True); txt(s,3.05,y+.12,2.75,.66,b,11,GRAY); txt(s,5.97,y+.12,2.15,.66,c,11,GRAY); txt(s,8.38,y+.12,3.9,.66,d,11,GRAY) txt(s,.92,1.22,2,.18,'CONDITION',9,GRAY,True); txt(s,3.05,1.22,2.75,.18,'TYPICAL CONTEXT',9,GRAY,True); txt(s,5.97,1.22,2.15,.18,'CLUES',9,GRAY,True); txt(s,8.38,1.22,3.9,.18,'TREATMENT FRAME',9,GRAY,True); footer(s,'Goldman-Cecil Medicine, Thyroid chapter; Robbins & Kumar Basic Pathology, Thyroid chapter.') #4 s=prs.slides.add_slide(blank); title(s,4,'Diagnosis: confirm dysfunction, then define cause') # flow steps=[('1','TSH\nfirst-line screen'),('2','Free T4 ± T3\nclassify dysfunction'),('3','Antibodies / uptake\nidentify etiology'),('4','Ultrasound ± FNA\nif structural disease')] for i,(n,t) in enumerate(steps): x=.78+i*3.12; rect(s,x,2.0,2.55,1.23,SKY,True,TEAL); txt(s,x+.16,2.18,.35,.35,n,20,TEAL,True); txt(s,x+.62,2.18,1.7,.62,t,14,NAVY,True) if i<3: txt(s,x+2.58,2.42,.35,.3,'›',26,TEAL,True,align=PP_ALIGN.CENTER) card(s,.78,4.05,3.7,1.65,'Interpret in context','Pregnancy, acute illness, drugs, biotin use and pituitary disease can alter interpretation.',GOLD) card(s,4.8,4.05,3.7,1.65,'Avoid overtesting','Test when clinical suspicion exists. Incidental imaging findings require structured nodule assessment.',TEAL) card(s,8.82,4.05,3.7,1.65,'Use imaging wisely','Ultrasound evaluates nodules and cervical nodes; cytology and molecular tests refine indeterminate results.',RED) footer(s,'Goldman-Cecil Medicine, Thyroid chapter; ACR TI-RADS framework.') #5 s=prs.slides.add_slide(blank); title(s,5,'Hypothyroidism: optimize standard therapy') card(s,.7,1.55,3.75,4.75,'Foundation: levothyroxine','• Standard replacement for overt primary hypothyroidism\n\n• Dose and monitoring individualized by age, cardiac disease, pregnancy and etiology\n\n• TSH guides most primary hypothyroidism management',TEAL) card(s,4.8,1.55,3.75,4.75,'When symptoms persist','• Verify diagnosis and biochemical target\n\n• Review timing, adherence and absorption interactions\n\n• Consider comorbidities and alternative causes before changing therapy',GOLD) card(s,8.9,1.55,3.75,4.75,'Evidence-informed caution','Routine use of desiccated thyroid extract or combination therapy is not established as superior for most patients. Discuss uncertainty and safety.',RED) pill(s,4.9,6.55,3.55,'Aim: biochemical euthyroidism + patient-centered review',NAVY) footer(s,'ATA hypothyroidism guidance; Riis et al. Thyroid 2024, systematic review (PMID 38526391).') #6 s=prs.slides.add_slide(blank); title(s,6,'Hyperthyroidism: treatment is cause- and patient-specific') for i,(h,b,c) in enumerate([('Stabilize symptoms','Beta-blocker when appropriate; assess severity and urgent complications.',TEAL),('Control hormone excess','Methimazole is commonly preferred; PTU has selected indications. Monitor for important adverse effects.',GOLD),('Choose definitive treatment','Radioactive iodine or surgery may be appropriate depending on etiology, recurrence, goiter, eye disease and patient preference.',RED)]): card(s,.75+i*4.16,1.65,3.65,2.45,h,b,c) txt(s,.85,4.75,11.5,.3,'Key decision points',16,NAVY,True); bullet(s,.88,5.15,11.4,['Graves disease: assess thyroid eye disease, pregnancy plans and relapse risk.','Toxic nodules: definitive treatment is often favored because remission with antithyroid drugs is unlikely.','Thyroid storm or severe thyrotoxicosis needs urgent specialist-directed treatment.'],15) footer(s,'Goldman-Cecil Medicine, Thyroid chapter. Clinical therapy should follow local guidance and specialist assessment.') #7 s=prs.slides.add_slide(blank); title(s,7,'Nodules: a risk-stratified pathway prevents overtreatment') s.shapes.add_picture(IMG, Inches(.7), Inches(1.48), width=Inches(4.45), height=Inches(4.85)) card(s,5.55,1.55,6.55,1.25,'1. Ultrasound pattern + size','Composition, echogenicity, margins, shape and echogenic foci help estimate risk and select patients for fine-needle aspiration.',TEAL) card(s,5.55,3.05,6.55,1.25,'2. Cytology ± molecular testing','Molecular testing can refine risk in selected indeterminate cytology samples. It complements, not replaces, clinical judgment.',GOLD) card(s,5.55,4.55,6.55,1.25,'3. Surveillance or intervention','Many benign/asymptomatic nodules can be observed. Intervention is considered for symptoms, cosmetic concern, growth or cancer risk.',RED) footer(s,'Image: ACR TI-RADS framework reproduced in Goldman-Cecil Medicine, E-Figure 207-4. Text: Goldman-Cecil Medicine.') #8 s=prs.slides.add_slide(blank); title(s,8,'Minimally invasive treatment: thermal ablation') # center pathway rect(s,5.0,1.7,3.35,.78,MINT,True,TEAL); txt(s,5.12,1.95,3.1,.25,'Symptomatic benign nodule',17,NAVY,True,align=PP_ALIGN.CENTER) for x,label,body,col in [(1.0,'Radiofrequency ablation','Alternating current produces thermal coagulation and volume reduction.',TEAL),(5.0,'Microwave / laser','Other thermal approaches available in selected centers.',GOLD),(9.0,'Surgery','Preferred when cancer is suspected, large goiter or another surgical indication exists.',RED)]: rect(s,x,3.3,3.25,2.15,WHITE,True,RGBColor(220,228,230)); txt(s,x+.17,3.58,2.9,.32,label,16,NAVY,True); txt(s,x+.17,4.12,2.9,.7,body,13,GRAY); rect(s,x,5.15,3.25,.08,col) txt(s,.8,6.15,11.8,.45,'Best-established indication: symptomatic, nonfunctioning, benign nodules after appropriate confirmation of low malignancy risk.',15,INK,True,align=PP_ALIGN.CENTER) footer(s,'Sabiston Textbook of Surgery, Thyroid Ablation Techniques, pp. 394-416; Goldman-Cecil Medicine, Treatment section.') #9 s=prs.slides.add_slide(blank); title(s,9,'Thyroid eye disease: target inflammation and protect vision') card(s,.75,1.65,3.65,4.75,'Assess activity and severity','• Symptoms: pain, redness, diplopia\n• Signs: proptosis, lid retraction, corneal exposure\n• Identify sight-threatening disease urgently\n\nSmoking cessation and restoration of euthyroidism are central to care.',TEAL) card(s,4.85,1.65,3.65,4.75,'Active moderate-to-severe disease','Systemic glucocorticoids and other immunomodulatory strategies may be used by specialist teams. Teprotumumab targets IGF-1 receptor and is an option in some jurisdictions.',GOLD) card(s,8.95,1.65,3.65,4.75,'Rehabilitative phase','Persistent functional or cosmetic impairment may require orbital decompression, strabismus surgery or eyelid procedures after disease stabilization.',RED) footer(s,'Wong & Chelnis. Front Ophthalmol 2024, systematic review (PMID 38984136). Treatment availability and indications vary by region.') #10 s=prs.slides.add_slide(blank); title(s,10,'Differentiated thyroid cancer: less treatment for lower-risk disease') # timeline for i,(yr,h,b,c) in enumerate([('Diagnosis','US + FNA\n± molecular data',TEAL),('Initial therapy','Lobectomy or total\nthyroidectomy by risk',GOLD),('Adjuvant therapy','Selective radioactive iodine\nwhen benefit is expected',RED),('Follow-up','Thyroglobulin + imaging\nresponse-adapted surveillance',NAVY)]): x=.8+i*3.12; s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x+.8),Inches(2.0),Inches(1.0),Inches(1.0)).fill.solid(); s.shapes[-1].fill.fore_color.rgb=c; s.shapes[-1].line.color.rgb=c; txt(s,x+.8,2.3,1,.22,str(i+1),15,WHITE,True,align=PP_ALIGN.CENTER); txt(s,x,3.3,2.6,.3,h,16,NAVY,True,align=PP_ALIGN.CENTER); txt(s,x,3.72,2.6,.6,b,13,GRAY,align=PP_ALIGN.CENTER) if i<3: rect(s,x+2.12,2.45,1.0,.08,RGBColor(190,205,210)) rect(s,.8,5.45,11.75,.63,SKY,True,TEAL); txt(s,1.0,5.65,11.3,.22,'2025 ATA update: lobectomy is recommended for appropriately selected intrathyroidal, node-negative cancers ≤2 cm.',14,NAVY,True,align=PP_ALIGN.CENTER) footer(s,'American Thyroid Association, 2025 differentiated thyroid cancer guideline summaries.') #11 s=prs.slides.add_slide(blank); title(s,11,'Advanced cancer: molecularly directed and focal options') card(s,.72,1.55,3.75,4.9,'Define the problem','Radioiodine-refractory or progressive disease requires reassessment of tumor biology, symptoms, disease distribution and treatment goals.',NAVY) card(s,4.8,1.55,3.75,4.9,'Match therapy to biology','Genomic profiling may identify actionable alterations. Multikinase inhibitors and selective targeted therapies can be considered in progressive disease.',TEAL) card(s,8.88,1.55,3.75,4.9,'Use local control strategically','Surgery, radiotherapy or percutaneous thermal ablation may help control symptomatic, solitary or oligometastatic lesions in multidisciplinary care.',RED) footer(s,'Zhang et al. J Clin Endocrinol Metab 2025, meta-analysis (PMID 39292866); ATA 2025 DTC guideline updates.') #12 s=prs.slides.add_slide(blank); title(s,12,'Take-home messages') for i,(h,b,c) in enumerate([('Treat the patient, not the lab alone','Interpret biochemical results with symptoms, cause, comorbidities and life stage.',TEAL),('Use risk to reduce harm','Structured imaging, cytology and molecular tools help avoid unnecessary biopsy and surgery.',GOLD),('New options expand choice','Thermal ablation, biologics and targeted therapies complement, rather than replace, established care.',RED),('Shared decisions matter','Balance efficacy, adverse effects, access, follow-up burden and patient priorities.',NAVY)]): x=.75+(i%2)*6.15; y=1.55+(i//2)*2.35; card(s,x,y,5.7,1.85,h,b,c) rect(s,.75,6.45,11.9,.35,NAVY,True); txt(s,.9,6.54,11.6,.16,'Clinical note: management should be individualized with endocrine, surgical, ophthalmology and oncology input when needed.',10,WHITE,False,align=PP_ALIGN.CENTER) footer(s,'Selected sources: Goldman-Cecil Medicine; Sabiston Textbook of Surgery; ATA 2025 DTC guideline summaries; PubMed PMIDs 38526391, 38984136, 39292866.') # sources 13 s=prs.slides.add_slide(blank); title(s,13,'Selected references') refs=['Goldman-Cecil Medicine. Thyroid chapter and treatment section.','Sabiston Textbook of Surgery. Thyroid Ablation Techniques, pp. 394-416.','Ringel MD et al. 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer. Thyroid. 2025;35:841-985.','Riis KR et al. Desiccated thyroid extract for hypothyroidism: systematic review. Thyroid. 2024. PMID: 38526391.','Wong AS, Chelnis JG. Ocular surface treatments in thyroid eye disease: systematic review. Front Ophthalmol. 2024. PMID: 38984136.','Zhang Y et al. Targeted therapy for radioiodine-refractory differentiated thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab. 2025. PMID: 39292866.','American College of Radiology. TI-RADS framework for thyroid nodule assessment.'] txt(s,.82,1.55,11.65,4.95,'\n'.join([f'{i+1}. {r}' for i,r in enumerate(refs)]),14,INK) rect(s,.82,6.25,11.65,.55,SKY,True,TEAL); txt(s,1.0,6.4,11.25,.18,'For educational use. Confirm local regulatory status, prescribing information and current guidelines before clinical implementation.',10,NAVY,True,align=PP_ALIGN.CENTER) footer(s,'References current to September 2026.') prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/thyroid-presentation/src/create_deck.py" python - <<'PY' from pptx import Presentation p='/tmp/workspace/thyroid-presentation/output/Thyroid_Disorders_and_Treatment_Advances.pptx' r=Presentation(p) print('slides',len(r.slides)) for i,s in enumerate(r.slides,1): t=' '.join(sh.text for sh in s.shapes if hasattr(sh,'text_frame') and sh.has_text_frame) print(i,len(t),t[:60]) PY

~/thyroid-presentation/src/create_deck.py

python "/tmp/workspace/thyroid-presentation/src/create_deck.py" && python - <<'PY' from pptx import Presentation p='/tmp/workspace/thyroid-presentation/output/Thyroid_Disorders_and_Treatment_Advances.pptx' r=Presentation(p) print('slides',len(r.slides)) for i,s in enumerate(r.slides,1): t=' '.join(sh.text for sh in s.shapes if getattr(sh,'has_text_frame',False)) print(i, len(t)) PY ls -lh "/tmp/workspace/thyroid-presentation/output/Thyroid_Disorders_and_Treatment_Advances.pptx"

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/thyroid-presentation/output/Thyroid_Disorders_and_Treatment_Advances.pptx') prs=Presentation(str(p)) assert len(prs.slides)==13 assert p.stat().st_size>100000 for n,slide in enumerate(prs.slides,1): texts=[sh.text.strip() for sh in slide.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] assert texts, f'no text on slide {n}' print(f'Validated: {len(prs.slides)} slides; {p.stat().st_size} bytes; text present on every slide.') PY