from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
import io

# ── Colour palette ──────────────────────────────────────────────────────────
NAVY      = RGBColor(0x1A, 0x3A, 0x5C)   # slide header / accent
TEAL      = RGBColor(0x00, 0x86, 0x9B)   # section title bar
RED       = RGBColor(0xC0, 0x39, 0x2B)   # alert / warning
ORANGE    = RGBColor(0xE6, 0x7E, 0x22)   # highlight
GREEN     = RGBColor(0x1A, 0x7A, 0x4A)   # positive / safe
WHITE     = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_BG  = RGBColor(0xF0, 0xF4, 0xF8)  # slide background
DARK_TEXT = RGBColor(0x1C, 0x1C, 0x2E)
MID_GREY  = RGBColor(0x55, 0x65, 0x75)
GOLD      = RGBColor(0xF3, 0x9C, 0x12)

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]

# ── Helper utilities ─────────────────────────────────────────────────────────

def add_rect(slide, x, y, w, h, color, transparency=0):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = color
    shape.line.fill.background()
    return shape

def add_textbox(slide, x, y, w, h, text, size, bold=False, color=DARK_TEXT,
                align=PP_ALIGN.LEFT, italic=False, wrap=True, font="Calibri"):
    tb  = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf  = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    p   = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.name  = font
    run.font.size  = Pt(size)
    run.font.bold  = bold
    run.font.italic = italic
    run.font.color.rgb = color
    return tb, tf

def add_bullet_box(slide, x, y, w, h, items, size=16, color=DARK_TEXT,
                   bullet_color=TEAL, heading=None, heading_size=18,
                   font="Calibri", indent_level=0):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = 0
    tf.margin_top  = tf.margin_bottom = 0
    first = True
    if heading:
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first = False
        run = p.add_run()
        run.text = heading
        run.font.name  = font
        run.font.size  = Pt(heading_size)
        run.font.bold  = True
        run.font.color.rgb = bullet_color
    for item in items:
        p = tf.paragraphs[0] if (first and not heading) else tf.add_paragraph()
        first = False
        p.space_before = Pt(2)
        p.space_after  = Pt(2)
        run = p.add_run()
        if isinstance(item, tuple):
            bullet_char, text, clr = item
        else:
            bullet_char, text, clr = "●", item, color
        run.text = f"  {bullet_char}  {text}"
        run.font.name  = font
        run.font.size  = Pt(size)
        run.font.color.rgb = clr
    return tb, tf

def slide_bg(slide, color=LIGHT_BG):
    add_rect(slide, 0, 0, 13.333, 7.5, color)

def header_bar(slide, title, subtitle=None):
    add_rect(slide, 0, 0, 13.333, 1.1, NAVY)
    add_textbox(slide, 0.3, 0.12, 12.5, 0.6, title,
                size=28, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_textbox(slide, 0.3, 0.68, 12.5, 0.38, subtitle,
                    size=14, bold=False, color=RGBColor(0xCC, 0xDD, 0xEE),
                    align=PP_ALIGN.LEFT, italic=True)

def footer(slide, text="Thyroid Storm | Postgraduate Education"):
    add_rect(slide, 0, 7.2, 13.333, 0.3, NAVY)
    add_textbox(slide, 0.2, 7.22, 13.0, 0.22, text,
                size=9, color=RGBColor(0xBB, 0xCC, 0xDD), align=PP_ALIGN.LEFT)

def section_card(slide, x, y, w, h, title, body_lines, title_color=TEAL,
                  body_color=DARK_TEXT, bg=WHITE):
    add_rect(slide, x, y, w, 0.38, title_color)
    add_textbox(slide, x+0.1, y+0.04, w-0.2, 0.3, title,
                size=14, bold=True, color=WHITE)
    add_rect(slide, x, y+0.38, w, h-0.38, bg)
    tb = slide.shapes.add_textbox(Inches(x+0.12), Inches(y+0.44),
                                  Inches(w-0.24), Inches(h-0.54))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    first = True
    for line in body_lines:
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first = False
        p.space_before = Pt(1)
        run = p.add_run()
        if isinstance(line, tuple):
            run.text = line[0]
            run.font.bold = line[1]
            run.font.size = Pt(line[2])
            run.font.color.rgb = line[3]
        else:
            run.text = line
            run.font.size = Pt(13)
            run.font.color.rgb = body_color
        run.font.name = "Calibri"

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 1: Title Slide
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, NAVY)
add_rect(s, 0, 5.5, 13.333, 2.0, RGBColor(0x0D, 0x23, 0x3A))
add_rect(s, 0.5, 1.6, 0.1, 4.2, TEAL)   # decorative bar

add_textbox(s, 0.8, 1.7, 11.5, 1.2,
            "THYROID STORM",
            size=52, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
add_textbox(s, 0.8, 2.95, 11.5, 0.55,
            "Recognition, Scoring & Emergency Management",
            size=22, bold=False, color=RGBColor(0x7E, 0xC8, 0xE3),
            align=PP_ALIGN.LEFT, italic=True)
add_textbox(s, 0.8, 3.7, 11.5, 0.45,
            "Thyrotoxic Crisis · A Life-Threatening Emergency",
            size=17, color=RGBColor(0xCC, 0xDD, 0xEE), align=PP_ALIGN.LEFT)
add_textbox(s, 0.8, 5.6, 11.5, 0.4,
            "Postgraduate Medical Education  |  Internal Medicine / Emergency Medicine",
            size=13, color=RGBColor(0x88, 0xAA, 0xCC), align=PP_ALIGN.LEFT, italic=True)
add_textbox(s, 0.8, 6.1, 11.5, 0.4,
            "Sources: Tintinalli's Emergency Medicine 9e · Rosen's Emergency Medicine 10e · Katzung Pharmacology 16e",
            size=10, color=RGBColor(0x66, 0x88, 0xAA), align=PP_ALIGN.LEFT)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 2: Overview / Learning Objectives
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Learning Objectives", "What you will know by the end of this session")
footer(s)

add_rect(s, 0.4, 1.25, 12.5, 5.7, WHITE)

objectives = [
    "Define thyroid storm and distinguish it from uncomplicated thyrotoxicosis",
    "Recall the epidemiology, precipitants, and pathophysiology of thyroid storm",
    "Describe the clinical features across organ systems",
    "Apply the Burch-Wartofsky Point Scale (BWPS) for diagnosis",
    "Outline a structured, step-by-step management approach with drug doses",
    "Identify complications and manage them appropriately",
    "Know special populations: thyroid storm in pregnancy",
    "Determine appropriate disposition and follow-up",
]
for i, obj in enumerate(objectives):
    y = 1.45 + i * 0.65
    add_rect(s, 0.55, y, 0.5, 0.45, TEAL)
    add_textbox(s, 0.6, y+0.04, 0.4, 0.36, str(i+1),
                size=16, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(s, 1.2, y+0.02, 11.3, 0.44, obj,
                size=16, color=DARK_TEXT)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 3: Definitions & Epidemiology
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Definition & Epidemiology", "Understanding the scope of the problem")
footer(s)

# Definition box
section_card(s, 0.4, 1.2, 8.0, 2.7, "DEFINITION",
    [
        ("Thyroid storm = rare, life-threatening extreme thyrotoxicosis", True, 14, DARK_TEXT),
        ("● Multiorgan dysfunction on background of hyperthyroidism", False, 13, DARK_TEXT),
        ("● NOT just elevated thyroid hormones — it is a clinical diagnosis", False, 13, RED),
        ("● Often triggered by an acute insult (surgery, infection, iodine load)", False, 13, DARK_TEXT),
        ("● Untreated mortality → approaches 100%", False, 13, RED),
        ("● With prompt treatment, mortality 10–30%", False, 13, GREEN),
    ])

# Epidemiology box
section_card(s, 0.4, 4.05, 8.0, 2.8, "EPIDEMIOLOGY",
    [
        ("● Rare: <1% of hospital admissions for thyrotoxicosis", False, 13, DARK_TEXT),
        ("● More common in women (Graves disease predominance)", False, 13, DARK_TEXT),
        ("● Peak incidence 3rd–5th decade", False, 13, DARK_TEXT),
        ("● In up to 25% of cases, no precipitant is identified", False, 13, ORANGE),
    ])

# Key stat callout
add_rect(s, 9.0, 1.2, 4.0, 5.65, RGBColor(0xFF, 0xF3, 0xE0))
add_rect(s, 9.0, 1.2, 4.0, 0.4, ORANGE)
add_textbox(s, 9.05, 1.22, 3.9, 0.34, "KEY NUMBERS", size=13, bold=True, color=WHITE)

stats = [
    ("~100%", "Untreated mortality", RED),
    ("10–30%", "Mortality with treatment", ORANGE),
    ("1%", "Hospital admissions\nfor thyrotoxicosis", TEAL),
    ("25%", "Cases with no\nprecipitant found", MID_GREY),
]
for i, (num, label, clr) in enumerate(stats):
    y = 1.75 + i * 1.28
    add_textbox(s, 9.1, y, 3.8, 0.55, num, size=30, bold=True, color=clr, align=PP_ALIGN.CENTER)
    add_textbox(s, 9.1, y+0.5, 3.8, 0.48, label, size=12, color=MID_GREY, align=PP_ALIGN.CENTER)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 4: Precipitants
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Precipitants of Thyroid Storm", "Always search for the trigger")
footer(s)

cats = [
    ("Infection / Sepsis", ["Pneumonia", "UTI", "Meningitis", "Abscess"], TEAL),
    ("Surgical / Trauma", ["Thyroid surgery", "Any general surgery", "Physical trauma", "Palpation of gland"], NAVY),
    ("Cardiovascular", ["Myocardial infarction", "Pulmonary embolism", "Cerebrovascular accident", "Heart failure"], RED),
    ("Endocrine / Metabolic", ["Diabetic ketoacidosis", "Hyperosmolar coma", "Adrenal insufficiency"], ORANGE),
    ("Drug / Iodine Related", ["Radioactive iodine Rx", "Iodine contrast dye", "Amiodarone", "Withdrawal of ATD"], GREEN),
    ("Obstetric", ["Labor & delivery", "Eclampsia / Pre-eclampsia", "Hyperemesis gravidarum"], RGBColor(0x7D, 0x3C, 0x98)),
]

positions = [(0.35,1.2),(4.6,1.2),(8.85,1.2),(0.35,4.1),(4.6,4.1),(8.85,4.1)]
for (x,y), (title, items, clr) in zip(positions, cats):
    add_rect(s, x, y, 4.1, 0.4, clr)
    add_textbox(s, x+0.1, y+0.06, 3.9, 0.3, title, size=14, bold=True, color=WHITE)
    add_rect(s, x, y+0.4, 4.1, 2.8, WHITE)
    tb = s.shapes.add_textbox(Inches(x+0.15), Inches(y+0.5), Inches(3.8), Inches(2.6))
    tf = tb.text_frame; tf.word_wrap = True
    tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
    first=True
    for item in items:
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first=False
        p.space_before=Pt(3)
        run=p.add_run(); run.text=f"▸  {item}"
        run.font.name="Calibri"; run.font.size=Pt(14); run.font.color.rgb=DARK_TEXT

add_textbox(s, 0.35, 6.9, 12.6, 0.25,
    "★  Unknown cause identified in up to 25% of cases (Tintinalli's 9e)",
    size=11, color=MID_GREY, italic=True)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 5: Pathophysiology
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Pathophysiology", "Why the storm develops")
footer(s)

# Flow diagram using boxes and arrows
steps = [
    ("Underlying\nHyperthyroidism\n(Graves / Toxic MNG)", TEAL, 0.5),
    ("Acute\nPrecipitant\n(infection, surgery…)", ORANGE, 3.2),
    ("↑ Free T3/T4\n+ ↑ Adrenergic\nReceptor Sensitivity", RED, 5.9),
    ("Hyperadrenergic\nState", NAVY, 8.6),
    ("Multiorgan\nDysfunction", RGBColor(0x6C, 0x3A, 0x83), 11.3),
]

for title, clr, x in steps:
    add_rect(s, x, 1.4, 2.5, 1.5, clr)
    tb = s.shapes.add_textbox(Inches(x+0.1), Inches(1.45), Inches(2.3), Inches(1.4))
    tf=tb.text_frame; tf.word_wrap=True
    tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
    p=tf.paragraphs[0]; p.alignment=PP_ALIGN.CENTER
    run=p.add_run(); run.text=title
    run.font.name="Calibri"; run.font.size=Pt(13); run.font.bold=True
    run.font.color.rgb=WHITE
    if x < 11.3:
        add_textbox(s, x+2.5, 1.95, 0.7, 0.5, "→", size=24, bold=True,
                    color=MID_GREY, align=PP_ALIGN.CENTER)

# Consequences column
cons = [
    ("Fever / Hyperpyrexia", RED),
    ("Tachycardia / AF / High-output HF", RED),
    ("CNS: Agitation → Coma", NAVY),
    ("GI: Nausea, Vomiting, Diarrhoea, Jaundice", ORANGE),
    ("Thyroid hormones displace from binding proteins → ↑ Free fractions", MID_GREY),
    ("Negative TSH feedback broken — autonomous secretion", MID_GREY),
]
add_rect(s, 0.4, 3.2, 12.5, 0.32, TEAL)
add_textbox(s, 0.5, 3.22, 12.2, 0.28, "DOWNSTREAM CONSEQUENCES", size=13, bold=True, color=WHITE)

for i, (text, clr) in enumerate(cons):
    y = 3.6 + i * 0.57
    add_rect(s, 0.4, y, 0.35, 0.42, clr)
    add_textbox(s, 0.85, y+0.04, 11.9, 0.4, text, size=15, color=DARK_TEXT)

add_textbox(s, 0.4, 6.9, 12.5, 0.28,
    "Note: Total T3/T4 levels may NOT be elevated — free fractions are the key (Tintinalli's 9e)",
    size=11, italic=True, color=MID_GREY)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 6: Clinical Features
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Clinical Features", "Multiorgan presentation — the clinical storm")
footer(s)

systems = [
    ("Thermoregulatory", ["Marked fever 40–41°C (104–106°F)", "Diaphoresis, heat intolerance"], RED),
    ("Cardiovascular", ["Extreme tachycardia (often out of proportion to fever)",
                        "Widened pulse pressure", "AF (10–35% of cases)",
                        "High-output cardiac failure", "Cardiovascular collapse"], RED),
    ("CNS", ["Mild: agitation, anxiety, tremor",
             "Moderate: delirium, psychosis",
             "Severe: seizures, coma", "Lid lag, stare, goiter, exophthalmos"], NAVY),
    ("GI / Hepatic", ["Nausea, vomiting, diarrhoea",
                      "Abdominal pain (common)",
                      "Jaundice / hepatic failure (poor prognosis)"], ORANGE),
    ("Metabolic", ["Hyperglycaemia or relative hypoglycaemia",
                   "Elevated LFTs (up to 30% on ATDs)",
                   "Raised cortisol (expected — stress response)",
                   "Low cortisol → suspect adrenal insufficiency"], GREEN),
]

col_xs = [0.35, 4.7, 9.05]
rows   = [(0, 1.2), (1, 1.2), (2, 1.2), (0, 4.05), (1, 4.05)]

for (ci, y_offset), (title, items, clr) in zip(rows, systems):
    x = col_xs[ci]
    add_rect(s, x, y_offset, 4.2, 0.38, clr)
    add_textbox(s, x+0.1, y_offset+0.04, 4.0, 0.3, title, size=14, bold=True, color=WHITE)
    add_rect(s, x, y_offset+0.38, 4.2, 2.65, WHITE)
    tb = s.shapes.add_textbox(Inches(x+0.15), Inches(y_offset+0.48), Inches(3.9), Inches(2.4))
    tf=tb.text_frame; tf.word_wrap=True
    tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
    first=True
    for item in items:
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first=False; p.space_before=Pt(2)
        run=p.add_run(); run.text=f"▸  {item}"
        run.font.name="Calibri"; run.font.size=Pt(13); run.font.color.rgb=DARK_TEXT

# Pearl box
add_rect(s, 9.05, 4.05, 4.2, 2.65, RGBColor(0xFF, 0xF8, 0xE1))
add_rect(s, 9.05, 4.05, 4.2, 0.38, GOLD)
add_textbox(s, 9.1, 4.07, 4.0, 0.32, "CLINICAL PEARL", size=13, bold=True, color=WHITE)
pearl = ("Tachycardia out of proportion\nto fever is a hallmark clue.\n\n"
         "Absence of goiter does NOT\nrule out thyroid storm —\nconsider factitious or ectopic source.")
add_textbox(s, 9.15, 4.5, 3.9, 2.1, pearl, size=13, color=DARK_TEXT, italic=True)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 7: Burch-Wartofsky Scoring
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Burch-Wartofsky Point Scale (BWPS)", "Diagnostic scoring — 1993, still the gold standard")
footer(s)

# interpretation box top-right
add_rect(s, 9.4, 1.15, 3.6, 3.3, RGBColor(0xE8, 0xF8, 0xEE))
add_rect(s, 9.4, 1.15, 3.6, 0.38, GREEN)
add_textbox(s, 9.5, 1.17, 3.4, 0.3, "INTERPRETATION", size=13, bold=True, color=WHITE)
interp = [
    ("≥ 45", "Thyroid STORM", RED, True),
    ("25 – 44", "Impending Storm", ORANGE, True),
    ("< 25", "Storm unlikely", GREEN, True),
]
for i, (score, label, clr, bold) in enumerate(interp):
    y = 1.65 + i*0.8
    add_rect(s, 9.5, y, 1.1, 0.52, clr)
    add_textbox(s, 9.52, y+0.07, 1.06, 0.38, score, size=16, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(s, 10.7, y+0.07, 2.2, 0.38, label, size=14, bold=bold, color=clr)

add_textbox(s, 9.5, 4.6, 3.5, 0.9,
    "⚠ No validated sensitivity/specificity published\n→ Clinical judgement remains essential",
    size=12, color=ORANGE, italic=True)

# Scoring table
categories = [
    ("Fever (°C / °F)", [
        ("37.2–37.7 / 99–99.9", "5"),
        ("37.8–38.2 / 100–100.9", "10"),
        ("38.3–38.8 / 101–101.9", "15"),
        ("38.9–39.4 / 102–102.9", "20"),
        ("39.5–39.9 / 103–103.9", "25"),
        ("≥ 40 / ≥ 104", "30"),
    ], TEAL),
    ("Tachycardia (bpm)", [
        ("90–109", "5"),
        ("110–119", "10"),
        ("120–129", "15"),
        ("130–139", "20"),
        ("≥ 140", "25"),
    ], NAVY),
    ("CNS Dysfunction", [
        ("None", "0"),
        ("Mild agitation", "10"),
        ("Delirium / psychosis / lethargy", "20"),
        ("Coma / seizures", "30"),
    ], RED),
    ("Heart Failure", [
        ("Absent", "0"),
        ("Mild (pedal oedema)", "5"),
        ("Moderate (bibasal rales)", "10"),
        ("Pulmonary oedema", "15"),
    ], ORANGE),
    ("AF present", [("Yes", "10"), ("No", "0")], RGBColor(0x7D, 0x3C, 0x98)),
    ("GI-Hepatic Sx", [
        ("None", "0"),
        ("N/V/Diarrhoea", "10"),
        ("Jaundice", "20"),
    ], GREEN),
    ("Precipitant", [("Present", "10"), ("Absent", "0")], GOLD),
]

col_w = 4.55
col_positions = [0.35, 4.95]
row_top = 1.2
col_idx = 0
row_y = row_top

for ci, (cat_title, entries, clr) in enumerate(categories):
    x = col_positions[col_idx]
    add_rect(s, x, row_y, col_w, 0.34, clr)
    add_textbox(s, x+0.08, row_y+0.04, col_w-0.16, 0.28, cat_title, size=13, bold=True, color=WHITE)
    entry_h = 0.3
    for j, (criterion, score) in enumerate(entries):
        ey = row_y + 0.34 + j*entry_h
        bg = WHITE if j % 2 == 0 else RGBColor(0xF5, 0xF8, 0xFC)
        add_rect(s, x, ey, col_w-0.6, entry_h, bg)
        add_rect(s, x+col_w-0.6, ey, 0.6, entry_h, RGBColor(0xE8, 0xF0, 0xFE))
        add_textbox(s, x+0.08, ey+0.02, col_w-0.76, entry_h-0.04, criterion, size=11, color=DARK_TEXT)
        add_textbox(s, x+col_w-0.56, ey+0.02, 0.5, entry_h-0.04, score, size=12, bold=True, color=NAVY, align=PP_ALIGN.CENTER)
    row_y += 0.34 + len(entries)*entry_h + 0.12
    if row_y > 6.5 or ci == 2:
        col_idx += 1
        row_y = row_top

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 8: Investigations
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Investigations", "Do NOT delay treatment waiting for results")
footer(s)

# Warning banner
add_rect(s, 0.35, 1.15, 12.6, 0.5, RED)
add_textbox(s, 0.5, 1.2, 12.3, 0.38,
    "⚠  Thyroid storm is a CLINICAL diagnosis — NEVER delay treatment waiting for labs",
    size=16, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

inv_cols = [
    ("Thyroid Function Tests", [
        "TSH: suppressed / undetectable",
        "Free T4 and Free T3: elevated",
        "Total T3/T4: may or may NOT be elevated",
        "Note: labs may be indistinguishable from uncomplicated thyrotoxicosis",
    ], TEAL),
    ("Haematology / Chemistry", [
        "FBC: leukocytosis (infection), anaemia",
        "Blood glucose: hypo- or hyperglycaemia",
        "Electrolytes: hyponatraemia (GI losses)",
        "Serum calcium: hypercalcaemia may occur",
        "LFTs: elevated in up to 30% on ATDs",
        "Serum cortisol: high expected; low → adrenal insufficiency",
    ], NAVY),
    ("Imaging / Monitoring", [
        "CXR: infection as precipitant, pulmonary oedema",
        "ECG: sinus tachycardia, AF, PVCs, heart block",
        "Bedside echo: high output failure, LV function",
        "CT brain (if needed): exclude CNS precipitant",
        "Blood cultures, urinalysis (search for sepsis)",
        "Continuous cardiac monitoring, pulse oximetry",
    ], ORANGE),
]

for i, (title, items, clr) in enumerate(inv_cols):
    x = 0.35 + i * 4.35
    add_rect(s, x, 1.75, 4.2, 0.38, clr)
    add_textbox(s, x+0.1, 1.77, 4.0, 0.32, title, size=14, bold=True, color=WHITE)
    add_rect(s, x, 2.13, 4.2, 4.8, WHITE)
    tb = s.shapes.add_textbox(Inches(x+0.15), Inches(2.2), Inches(3.9), Inches(4.6))
    tf=tb.text_frame; tf.word_wrap=True
    tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
    first=True
    for item in items:
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first=False; p.space_before=Pt(4)
        run=p.add_run(); run.text=f"●  {item}"
        run.font.name="Calibri"; run.font.size=Pt(13); run.font.color.rgb=DARK_TEXT

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 9: Treatment Overview — The 7-Step Approach
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Management: The 7-Step Approach", "Sequence matters — iodine MUST come after thionamide (≥1 hour)")
footer(s)

steps_data = [
    ("1", "Supportive Care", "O₂, IV access, monitoring, cooling, IVF + dextrose, antipyretics (paracetamol only — avoid aspirin!)", TEAL),
    ("2", "Block Adrenergic Effects", "Propranolol IV/PO  |  Esmolol infusion if needed  |  Avoid β-blockers if severe bronchospasm", NAVY),
    ("3", "Inhibit New Hormone Synthesis", "Thionamide FIRST: PTU 500–1000 mg load then 250 mg q4h  OR  Methimazole 20 mg q6h PO", RED),
    ("4", "Inhibit Hormone Release", "≥1 h AFTER Step 3 → Lugol's iodine 8–10 drops q6–8h  OR  SSKI 5 drops q6h", ORANGE),
    ("5", "Block T4→T3 Conversion", "Hydrocortisone 300 mg IV then 100 mg q8h  OR  Dexamethasone 2–4 mg IV q6h", GREEN),
    ("6", "Treat the Precipitant", "Empirical antibiotics if infection suspected  |  Identify and treat underlying cause", RGBColor(0x7D, 0x3C, 0x98)),
    ("7", "Prevent Reabsorption", "Cholestyramine 1–4 g PO BD for refractory / severe cases (blocks enterohepatic recirculation)", GOLD),
]

for i, (num, title, detail, clr) in enumerate(steps_data):
    y = 1.2 + i * 0.84
    add_rect(s, 0.35, y, 0.6, 0.72, clr)
    add_textbox(s, 0.35, y+0.1, 0.6, 0.52, num, size=24, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(s, 0.95, y, 2.8, 0.72, RGBColor(0xEE, 0xF2, 0xF7))
    add_textbox(s, 1.05, y+0.12, 2.65, 0.52, title, size=15, bold=True, color=clr)
    add_rect(s, 3.75, y, 9.2, 0.72, WHITE)
    add_textbox(s, 3.85, y+0.1, 9.0, 0.58, detail, size=13, color=DARK_TEXT)

add_rect(s, 0.35, 7.08, 12.6, 0.1, ORANGE)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 10: Drug Doses — Quick Reference
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Drug Doses — Quick Reference Card", "Core pharmacotherapy of thyroid storm")
footer(s)

drug_table = [
    ("CLASS",            "DRUG",              "DOSE / ROUTE",                                  "NOTES",                              "HDR"),
    ("β-Blocker",        "Propranolol",        "0.5–1 mg IV over 10 min; repeat 1–2 mg q few h\nOR 60–80 mg PO q4h",
                                               "Drug of choice; blocks T4→T3 peripherally",   False),
    ("",                 "Esmolol",            "250–500 µg/kg IV load then 50–100 µg/kg/min",  "Preferred if bronchospasm concern",   False),
    ("Thionamide",       "PTU",                "500–1000 mg PO load, then 250 mg q4h",         "Also blocks T4→T3; preferred in 1st trimester", False),
    ("",                 "Methimazole",        "20 mg q6h PO",                                 "AVOID in 1st trimester; faster onset", False),
    ("Iodine",           "Lugol's solution",   "8–10 drops PO q6–8h",                          "≥1 h AFTER thionamide",               False),
    ("",                 "SSKI",               "5 drops (250 mg) PO q6h",                      "≥1 h AFTER thionamide",               False),
    ("Steroid",          "Hydrocortisone",     "300 mg IV then 100 mg q8h",                    "Blocks T4→T3; treats relative adrenal insufficiency", False),
    ("",                 "Dexamethasone",      "2–4 mg IV q6h",                                "Alternative to hydrocortisone",        False),
    ("Bile acid resin",  "Cholestyramine",     "1–4 g PO BD",                                  "Blocks enterohepatic recirculation; refractory cases", False),
    ("Antipyretic",      "Paracetamol",        "325–650 mg PO/PR q4–6h",                       "⚠ AVOID aspirin — displaces T4 from binding proteins", False),
]

col_ws = [1.7, 1.9, 4.2, 4.4]
col_xs_t = [0.35, 2.05, 3.95, 8.15]
col_labels = ["CLASS", "DRUG", "DOSE / ROUTE", "NOTES"]

# Header
for j, (cx, cw, label) in enumerate(zip(col_xs_t, col_ws, col_labels)):
    add_rect(s, cx, 1.15, cw, 0.38, NAVY)
    add_textbox(s, cx+0.07, 1.17, cw-0.14, 0.32, label, size=13, bold=True, color=WHITE)

for i, row in enumerate(drug_table[1:]):
    clss, drug, dose, note, _ = row
    y = 1.53 + i * 0.54
    bg = WHITE if i % 2 == 0 else RGBColor(0xF2, 0xF5, 0xFA)
    for j, (cx, cw, val) in enumerate(zip(col_xs_t, col_ws, [clss, drug, dose, note])):
        add_rect(s, cx, y, cw, 0.54, bg)
        clr = TEAL if j == 0 and val else (RED if j == 1 else DARK_TEXT)
        add_textbox(s, cx+0.07, y+0.04, cw-0.12, 0.46, val, size=11, color=clr,
                    bold=(j in [0, 1]))

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 11: Management of Specific Complications
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Managing Specific Complications", "Targeted therapy beyond the 7-step approach")
footer(s)

comps = [
    ("Atrial Fibrillation (10–35%)", [
        "Rate control with IV propranolol (preferred) or esmolol",
        "Avoid digoxin as first-line (needs high doses; risk of toxicity)",
        "Cardioversion often unsuccessful until euthyroid state restored",
        "Anticoagulation: consider if AF persists >48 h",
    ], NAVY),
    ("High-Output Cardiac Failure", [
        "Cautious diuresis (furosemide)",
        "Beta-blockers reduce heart rate and afterload",
        "Avoid vasodilators if hypotensive",
        "ICU-level monitoring required",
    ], RED),
    ("Hyperthermia", [
        "Paracetamol 325–650 mg q4–6h (NOT aspirin — raises free T4)",
        "Active cooling: ice packs, cooling blanket, ice lavage",
        "Target temperature <38.5°C",
    ], ORANGE),
    ("Agitation / Seizures", [
        "Lorazepam 1–2 mg IV or diazepam 5–10 mg IV",
        "Reduces central sympathetic outflow",
        "If seizures: standard AED protocol",
    ], TEAL),
    ("Adrenal Insufficiency (suspected)", [
        "Low cortisol despite expected stress response",
        "Hydrocortisone covers both relative AI and blocks T4→T3",
        "Do not wait for formal testing — treat empirically",
    ], GREEN),
    ("Refractory / Severe Cases", [
        "Plasmapheresis / thyroid hormone plasma exchange",
        "Emergency thyroidectomy (last resort)",
        "ECMO support in cardiovascular collapse",
        "Cholestyramine for enterohepatic recirculation",
    ], RGBColor(0x6C, 0x3A, 0x83)),
]

for i, (title, items, clr) in enumerate(comps):
    col = i % 3
    row = i // 3
    x = 0.35 + col * 4.35
    y = 1.2 + row * 3.05
    add_rect(s, x, y, 4.2, 0.36, clr)
    add_textbox(s, x+0.1, y+0.04, 4.0, 0.28, title, size=13, bold=True, color=WHITE)
    add_rect(s, x, y+0.36, 4.2, 2.55, WHITE)
    tb = s.shapes.add_textbox(Inches(x+0.15), Inches(y+0.44), Inches(3.9), Inches(2.3))
    tf=tb.text_frame; tf.word_wrap=True
    tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
    first=True
    for item in items:
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first=False; p.space_before=Pt(3)
        run=p.add_run(); run.text=f"●  {item}"
        run.font.name="Calibri"; run.font.size=Pt(12.5); run.font.color.rgb=DARK_TEXT

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 12: Thyroid Storm in Pregnancy
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Special Population: Thyroid Storm in Pregnancy", "Drug safety and obstetric considerations")
footer(s)

add_rect(s, 0.35, 1.15, 12.6, 0.5, RGBColor(0x7D, 0x3C, 0x98))
add_textbox(s, 0.5, 1.2, 12.3, 0.38,
    "Thyroid storm in pregnancy carries HIGH maternal and fetal mortality — early obstetric and endocrine consultation is MANDATORY",
    size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

left_items = [
    ("Drug Choices in Pregnancy", [
        "PTU preferred in 1st trimester (methimazole teratogenic)",
        "Methimazole safe from 2nd trimester onwards",
        "Propranolol: safe short-term; prolonged use → IUGR, neonatal bradycardia",
        "Lugol's iodine: use with caution; may cause fetal hypothyroidism",
        "Steroids: hydrocortisone / betamethasone preferred",
        "⚠ PTU: rare severe maternal hepatotoxicity — monitor LFTs",
    ], TEAL),
]
right_items = [
    ("Precipitants Unique to Pregnancy", [
        "Hyperemesis gravidarum (hCG-driven hyperthyroidism)",
        "Hydatidiform mole (hCG-secreting tumor)",
        "Gestational thyrotoxicosis",
        "Labor, delivery, eclampsia",
    ], RGBColor(0x7D, 0x3C, 0x98)),
    ("Monitoring / Disposition", [
        "Continuous fetal monitoring in viable gestations",
        "MFM + Endocrinology + ICU team involvement",
        "ICU admission for mother",
        "Neonatal team on standby if delivery likely",
        "Radioactive iodine: CONTRAINDICATED in pregnancy",
    ], ORANGE),
]

for j, (title, items, clr) in enumerate(left_items):
    add_rect(s, 0.35, 1.75, 6.3, 0.36, clr)
    add_textbox(s, 0.45, 1.77, 6.1, 0.3, title, size=14, bold=True, color=WHITE)
    add_rect(s, 0.35, 2.11, 6.3, 4.95, WHITE)
    tb = s.shapes.add_textbox(Inches(0.5), Inches(2.18), Inches(6.0), Inches(4.7))
    tf=tb.text_frame; tf.word_wrap=True
    tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
    first=True
    for item in items:
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first=False; p.space_before=Pt(5)
        run=p.add_run(); run.text=f"●  {item}"
        run.font.name="Calibri"; run.font.size=Pt(14); run.font.color.rgb=DARK_TEXT

for j, (title, items, clr) in enumerate(right_items):
    y = 1.75 + j * 3.15
    add_rect(s, 6.85, y, 6.2, 0.36, clr)
    add_textbox(s, 6.95, y+0.04, 6.0, 0.3, title, size=14, bold=True, color=WHITE)
    add_rect(s, 6.85, y+0.36, 6.2, 2.62, WHITE)
    tb = s.shapes.add_textbox(Inches(7.0), Inches(y+0.44), Inches(5.9), Inches(2.4))
    tf=tb.text_frame; tf.word_wrap=True
    tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
    first=True
    for item in items:
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first=False; p.space_before=Pt(4)
        run=p.add_run(); run.text=f"●  {item}"
        run.font.name="Calibri"; run.font.size=Pt(13); run.font.color.rgb=DARK_TEXT

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 13: Differential Diagnosis
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Differential Diagnosis", "Conditions that mimic thyroid storm")
footer(s)

diffs = [
    ("Sympathomimetic Toxicity", "Cocaine, amphetamines, MDMA — tachycardia, hyperthermia, agitation. No goiter, no elevated TFTs.", TEAL),
    ("Anticholinergic Crisis", "Dry skin, urinary retention, mydriasis. Hot but dry. No sweating.", NAVY),
    ("Serotonin Syndrome", "Clonus (pathognomonic), hyperreflexia, rigidity. Drug history — SSRIs, MAOIs.", RED),
    ("Neuroleptic Malignant Syndrome", "Muscle rigidity, bradykinesia, lead-pipe rigidity. Antipsychotic use history.", ORANGE),
    ("Malignant Hyperthermia", "Triggering anaesthetic agents, masseter spasm, dramatically elevated CK.", GREEN),
    ("Heat Stroke", "Environmental exposure, no thyroid history, TFTs normal.", RGBColor(0x7D, 0x3C, 0x98)),
    ("Sepsis / Meningitis", "Can coexist as precipitant! CXR, blood cultures, LP if suspected.", RGBColor(0x0D, 0x6E, 0xFD)),
    ("Phaeochromocytoma", "Episodic hypertension, sweating. Elevated catecholamines, normal TFTs.", GOLD),
    ("Apathetic Hyperthyroidism (elderly)", "No classic adrenergic signs; weight loss, AF, weakness predominate. Easy to miss.", MID_GREY),
]

for i, (diag, desc, clr) in enumerate(diffs):
    col = i % 3
    row = i // 3
    x = 0.35 + col * 4.35
    y = 1.2 + row * 1.92
    add_rect(s, x, y, 4.2, 0.34, clr)
    add_textbox(s, x+0.1, y+0.04, 4.0, 0.28, diag, size=13, bold=True, color=WHITE)
    add_rect(s, x, y+0.34, 4.2, 1.44, WHITE)
    add_textbox(s, x+0.15, y+0.42, 3.9, 1.28, desc, size=12, color=DARK_TEXT)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 14: Disposition & Prognosis
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
slide_bg(s)
header_bar(s, "Disposition, Prognosis & Definitive Treatment", "ICU admission is mandatory")
footer(s)

# Left column
add_rect(s, 0.35, 1.2, 6.15, 0.36, NAVY)
add_textbox(s, 0.45, 1.22, 5.95, 0.3, "IMMEDIATE DISPOSITION", size=14, bold=True, color=WHITE)
add_rect(s, 0.35, 1.56, 6.15, 2.6, WHITE)
disp_items = [
    "All thyroid storm patients → ICU admission",
    "Endocrinology consultation (emergency)",
    "If pregnant: Obstetrics + MFM + Neonatology",
    "Continuous cardiac monitoring + pulse oximetry",
    "Reassess BWPS score after 24–48 h of treatment",
    "Avoid premature discharge — storm can recur",
]
tb = s.shapes.add_textbox(Inches(0.5), Inches(1.62), Inches(5.8), Inches(2.4))
tf=tb.text_frame; tf.word_wrap=True; tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
first=True
for item in disp_items:
    p = tf.paragraphs[0] if first else tf.add_paragraph()
    first=False; p.space_before=Pt(4)
    run=p.add_run(); run.text=f"✔  {item}"
    run.font.name="Calibri"; run.font.size=Pt(13); run.font.color.rgb=DARK_TEXT

# Prognosis
add_rect(s, 0.35, 4.3, 6.15, 0.36, RED)
add_textbox(s, 0.45, 4.32, 5.95, 0.3, "PROGNOSIS & PREDICTORS OF DEATH", size=14, bold=True, color=WHITE)
add_rect(s, 0.35, 4.66, 6.15, 2.4, WHITE)
prog_items = [
    "Overall mortality with treatment: 10–30%",
    "Death: multiorgan failure, cardiac arrhythmia, HF, DIC, hypoxic brain injury",
    "Poor prognosis: jaundice, severe CNS depression, refractory HF",
    "Delayed recognition is the main preventable cause of death",
]
tb = s.shapes.add_textbox(Inches(0.5), Inches(4.72), Inches(5.8), Inches(2.2))
tf=tb.text_frame; tf.word_wrap=True; tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0
first=True
for item in prog_items:
    p = tf.paragraphs[0] if first else tf.add_paragraph()
    first=False; p.space_before=Pt(4)
    run=p.add_run(); run.text=f"⚠  {item}"
    run.font.name="Calibri"; run.font.size=Pt(13); run.font.color.rgb=DARK_TEXT

# Right column
add_rect(s, 6.8, 1.2, 6.2, 0.36, GREEN)
add_textbox(s, 6.9, 1.22, 6.0, 0.3, "DEFINITIVE / LONG-TERM TREATMENT", size=14, bold=True, color=WHITE)
add_rect(s, 6.8, 1.56, 6.2, 5.5, WHITE)
def_items = [
    ("Radioactive Iodine (¹³¹I)", "First-line ablative therapy post-storm (after euthyroid). Contraindicated in pregnancy / breastfeeding.", GREEN),
    ("Thyroidectomy", "If RAI contraindicated, large goiter, or patient preference. Requires pre-op preparation to euthyroid state.", ORANGE),
    ("Long-term ATDs", "Thionamides for 12–18 months; remission in ~50% of Graves disease. Monitor CBC and LFTs.", TEAL),
    ("Treat underlying cause", "Address Graves disease with immunosuppression; toxic nodule with ablation or surgery.", NAVY),
]
cur_y = 1.65
for title, desc, clr in def_items:
    add_rect(s, 6.9, cur_y, 0.12, 1.12, clr)
    add_textbox(s, 7.1, cur_y+0.02, 5.8, 0.34, title, size=14, bold=True, color=clr)
    add_textbox(s, 7.1, cur_y+0.34, 5.7, 0.78, desc, size=12, color=DARK_TEXT)
    cur_y += 1.2

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 15: Summary & Key Takeaways
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, NAVY)
add_rect(s, 0, 0, 13.333, 1.1, RGBColor(0x0D, 0x23, 0x3A))
add_textbox(s, 0.4, 0.12, 12.5, 0.8, "KEY TAKEAWAYS", size=32, bold=True,
            color=WHITE, align=PP_ALIGN.LEFT)
add_rect(s, 0.4, 1.05, 0.08, 6.1, TEAL)

takeaways = [
    ("Thyroid storm = clinical diagnosis", "Do NOT wait for labs. If it looks like thyroid storm, treat it.", TEAL, WHITE),
    ("Burch-Wartofsky ≥ 45 → storm", "Score 25–44 = impending storm. Apply at bedside immediately.", GOLD, WHITE),
    ("7-Step treatment in order", "Steps 3 then 4 sequence is critical — iodine MUST follow thionamide by ≥1 hour.", RED, WHITE),
    ("Block, Block, Block — then Release", "β-Blocker → Thionamide → Iodine → Steroid → Treat precipitant", ORANGE, WHITE),
    ("Aspirin is CONTRAINDICATED", "Displaces thyroid hormone from binding proteins — raises free T4/T3 levels.", RED, WHITE),
    ("Mortality 10–30% even with treatment", "ICU admission, multidisciplinary team, and early endocrinology consultation save lives.", RGBColor(0x7D, 0x3C, 0x98), WHITE),
    ("Pregnancy: PTU in 1st trimester", "Methimazole teratogenic in 1st trimester. Obstetric + ICU + Endo team together.", RGBColor(0x0D, 0x6E, 0xFD), WHITE),
]

for i, (heading, detail, clr, txt_clr) in enumerate(takeaways):
    y = 1.15 + i * 0.84
    add_rect(s, 0.6, y, 4.5, 0.72, RGBColor(0x22, 0x44, 0x66))
    add_rect(s, 0.6, y, 0.22, 0.72, clr)
    add_textbox(s, 0.9, y+0.08, 4.1, 0.32, heading, size=14, bold=True, color=clr)
    add_textbox(s, 0.9, y+0.38, 4.1, 0.3, detail, size=11, color=RGBColor(0xCC, 0xDD, 0xEE))
    if i < len(takeaways) - 1:
        pass

# Two column summary on right
add_rect(s, 5.5, 1.15, 7.5, 5.88, RGBColor(0x0F, 0x2D, 0x4A))
add_rect(s, 5.5, 1.15, 7.5, 0.38, TEAL)
add_textbox(s, 5.6, 1.17, 7.3, 0.3, "MANAGEMENT AT A GLANCE", size=14, bold=True, color=WHITE)

mgt_summary = [
    ("STEP 1", "O₂ + IV access + Cardiac monitor + Cooling + IVF-D5W",   TEAL),
    ("STEP 2", "Propranolol IV (0.5–1 mg) or PO (60–80 mg q4h)",           NAVY),
    ("STEP 3", "PTU 500–1000 mg LOAD then 250 mg q4h  [or MMI 20 mg q6h]", RED),
    ("STEP 4", "≥1 h later: Lugol's 8–10 drops q6–8h  OR  SSKI 5 drops q6h", ORANGE),
    ("STEP 5", "Hydrocortisone 300 mg IV then 100 mg q8h",                 GREEN),
    ("STEP 6", "Treat precipitant — antibiotics if infection suspected",    RGBColor(0x7D, 0x3C, 0x98)),
    ("STEP 7", "Cholestyramine 1–4 g BD if refractory",                    GOLD),
    ("ADMIT", "ICU + Endocrinology + consider Plasmapheresis if refractory",RGBColor(0xC0, 0x39, 0x2B)),
]
for i, (step, detail, clr) in enumerate(mgt_summary):
    y = 1.63 + i * 0.67
    add_rect(s, 5.6, y, 1.1, 0.56, clr)
    add_textbox(s, 5.62, y+0.08, 1.06, 0.38, step, size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(s, 6.8, y+0.06, 6.1, 0.48, detail, size=12, color=RGBColor(0xEE, 0xF4, 0xFF))

add_rect(s, 0, 7.2, 13.333, 0.3, RGBColor(0x0D, 0x23, 0x3A))
add_textbox(s, 0.3, 7.22, 13.0, 0.22,
    "Sources: Tintinalli's Emergency Medicine 9e · Rosen's Emergency Medicine 10e · Katzung Pharmacology 16e · Goodman & Gilman 14e",
    size=9, color=RGBColor(0x88, 0xAA, 0xCC), align=PP_ALIGN.LEFT)

# ── Save ────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/thyroid-storm-ppt/Thyroid_Storm_Management.pptx"
prs.save(out_path)
print(f"Saved: {out_path}")