mkdir -p /home/daytona/workspace/antithyroid-ppt && ls /home/daytona/workspace/a…

~/antithyroid-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Anti-Thyroid Drugs & Thyroid Disorders";

// ─── COLOUR PALETTE ───────────────────────────────────────
const DARK_BG   = "0D1B2A";   // deep navy
const MID_BG    = "1B2A3B";   // medium navy
const ACCENT    = "00B4D8";   // bright cyan
const ACCENT2   = "48CAE4";   // lighter cyan
const GREEN     = "2EC4B6";   // teal-green
const RED       = "E63946";   // alert red
const LIGHT     = "E0F7FA";   // pale sky
const WHITE     = "FFFFFF";
const YELLOW    = "FFD166";

// ─── HELPERS ──────────────────────────────────────────────
function titleSlide(title, subtitle) {
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    x: 0.6, y: 3.5, w: 12.1, h: 1.0,
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}

function sectionHeader(title, subtitle) {
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    fontSize: 36, bold: true, color: WHITE, align: "left", fontFace: "Calibri"
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    sl.addText(subtitle, {
      x: 0.5, y: 3.5, w: 12.3, h: 1.2,
      fontSize: 22, color: ACCENT2, align: "left", fontFace: "Calibri", italic: true
    });
  }
  return sl;
}

function addSlide(title, bullets, opts = {}) {
  const sl = pres.addSlide();
  sl.background = { color: opts.dark ? DARK_BG : "F5F9FC" };
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    fontSize: 22, bold: true, color: WHITE, align: "left", fontFace: "Calibri", margin: 0
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}

function twoColSlide(title, leftHeader, leftBullets, rightHeader, rightBullets, opts = {}) {
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    fontSize: 22, bold: true, color: WHITE, align: "left", fontFace: "Calibri", margin: 0
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  }));
  sl.addText(rArr, { x: 7.0, y: 1.55, w: 6.0, h: 5.7, valign: "top", margin: 0 });
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  sl.addShape(pres.ShapeType.line, { x: 6.65, y: 1.0, w: 0, h: 6.3, line: { color: "CCCCCC", width: 1 } });
  return sl;
}

function tableSlide(title, heads, rows, opts = {}) {
  const sl = pres.addSlide();
  sl.background = { color: "F5F9FC" };
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.8, fill: { color: DARK_BG }, line: { color: DARK_BG } });
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    tableRows.push(row.map((cell, ci) => ({
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  sl.addTable(tableRows, {
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    border: { type: "solid", color: "CCCCCC", pt: 0.5 },
    rowH: opts.rowH || 0.5,
    colW: opts.colW
  });
  return sl;
}

// ══════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════
titleSlide(
  "Anti-Thyroid Drugs &\nThyroid Disorders",
  "Mechanism · Dosage · Onset · Duration · Side Effects · Contraindications\nSigns & Symptoms of Hypo- and Hyperthyroidism"
);

// ══════════════════════════════════════════════
// SLIDE 2 – OVERVIEW / AGENDA
// ══════════════════════════════════════════════
addSlide("Presentation Outline", [
  "1.  Thyroid physiology & hormone biosynthesis overview",
  "2.  Classification of anti-thyroid drugs",
  "3.  Thioamides — Methimazole (Carbimazole) & Propylthiouracil (PTU)",
  "4.  Iodides & Radioactive Iodine (¹³¹I)",
  "5.  Beta-Blockers as adjuncts",
  "6.  Drug comparison table — Mechanism, Dosage, Onset, Duration",
  "7.  Side effects & contraindications — detailed per drug",
  "8.  Signs & Symptoms of Hypothyroidism",
  "9.  Signs & Symptoms of Hyperthyroidism",
  "10. Quick clinical pearls & summary",
], { fontSize: 17 });

// ══════════════════════════════════════════════
// SLIDE 3 – THYROID PHYSIOLOGY OVERVIEW
// ══════════════════════════════════════════════
addSlide("Thyroid Physiology — Quick Overview", [
  "Thyroid gland secretes T3 (triiodothyronine) and T4 (thyroxine) — regulated by TSH from pituitary",
  "Iodide is actively transported into thyroid cells via the sodium/iodide symporter (NIS)",
  "Thyroid peroxidase (TPO) oxidizes iodide → organification of thyroglobulin → forms MIT and DIT",
  "MIT + DIT coupling forms T3; DIT + DIT coupling forms T4",
  "T4 is the main secreted hormone; converted peripherally to active T3 by deiodinase enzymes",
  "Thyroid hormones regulate metabolism, growth, development, body temperature, and heart rate",
  "Anti-thyroid drugs target various steps in this biosynthetic pathway",
], { fontSize: 16 });

// ══════════════════════════════════════════════
// SLIDE 4 – CLASSIFICATION OF ANTI-THYROID DRUGS
// ══════════════════════════════════════════════
addSlide("Classification of Anti-Thyroid Drugs", [
  "1. THIOAMIDES (main class)",
  "    • Propylthiouracil (PTU) — 50 mg tablets",
  "    • Methimazole (MMI) — 5, 10, 20 mg tablets",
  "    • Carbimazole — 5, 10, 20 mg tablets (pro-drug of methimazole; used in UK/India)",
  "",
  "2. IODIDES",
  "    • Lugol's iodine (potassium iodide + iodine solution)",
  "    • Saturated solution of potassium iodide (SSKI)",
  "",
  "3. RADIOACTIVE IODINE",
  "    • Iodine-131 (¹³¹I) — used for ablation therapy",
  "",
  "4. IONIC INHIBITORS (rarely used)",
  "    • Perchlorate, thiocyanate — block iodide uptake",
  "",
  "5. ADJUNCTS",
  "    • Beta-blockers (propranolol, atenolol) — control adrenergic symptoms",
  "    • Glucocorticoids — inhibit T4 → T3 conversion (used in thyroid storm)",
], { fontSize: 14 });

// ══════════════════════════════════════════════
// SLIDE 5 – SECTION HEADER: THIOAMIDES
// ══════════════════════════════════════════════
sectionHeader("Thioamides", "Methimazole · Carbimazole · Propylthiouracil (PTU)");

// ══════════════════════════════════════════════
// SLIDE 6 – METHIMAZOLE: MOA & PHARMACOKINETICS
// ══════════════════════════════════════════════
addSlide("Methimazole (MMI) — Mechanism of Action", [
  "PRIMARY MOA: Inhibits thyroid peroxidase (TPO) — blocks organification of iodide (iodination of thyroglobulin)",
  "Also inhibits coupling reaction → prevents formation of T3 and T4 within the follicle",
  "Does NOT inhibit peripheral conversion of T4 → T3 (unlike PTU)",
  "Does NOT block iodide uptake by the thyroid gland",
  "Accumulates in thyroid tissue → prolonged intrathyroidal effect even with once-daily dosing",
  "Pro-drug Carbimazole is rapidly and completely converted to methimazole (1 mg carbimazole ≈ 0.6 mg methimazole)",
  "Oral bioavailability: ~80–95% | Half-life: 4–6 hours (but intrathyroidal activity lasts much longer)",
], { fontSize: 15 });

// ══════════════════════════════════════════════
// SLIDE 7 – METHIMAZOLE: DOSAGE, ONSET, DURATION
// ══════════════════════════════════════════════
addSlide("Methimazole — Dosage, Onset & Duration", [
  "DOSAGE:",
  "    • Initial (mild-moderate hyperthyroidism): 15–30 mg/day in single or divided doses",
  "    • Initial (severe hyperthyroidism): 30–60 mg/day in divided doses",
  "    • Once-daily dosing acceptable (good intrathyroidal accumulation)",
  "    • Maintenance: 5–15 mg once daily",
  "    • Carbimazole equivalent: 1.5× the methimazole dose (e.g., 30 mg carbimazole → 20 mg methimazole)",
  "",
  "ONSET OF CLINICAL EFFECT:",
  "    • Biochemical effect (reduced T4 synthesis) begins within 1–2 hours",
  "    • Clinical improvement typically seen in 2–4 weeks (depends on pre-stored hormone depletion)",
  "    • Euthyroid state usually achieved in 6–12 weeks",
  "",
  "DURATION:",
  "    • Intrathyroidal half-life: ~20 hours → supports once-daily dosing",
  "    • Treatment course: 12–18 months for Graves disease",
  "    • Remission rate: 40–50% after completing full course",
], { fontSize: 14 });

// ══════════════════════════════════════════════
// SLIDE 8 – METHIMAZOLE: SIDE EFFECTS
// ══════════════════════════════════════════════
addSlide("Methimazole — Side Effects", [
  "MINOR (5–10% of patients):",
  "    • Skin rash, urticaria, pruritus — most common; often manageable with antihistamines",
  "    • Arthralgia, myalgia",
  "    • Nausea, gastrointestinal upset",
  "    • Taste disturbance, parotid swelling",
  "",
  "MAJOR (< 1% but serious):",
  "    • Agranulocytosis — most feared complication; sore throat + fever → STOP drug immediately; check CBC with differential",
  "    • Aplastic anemia (rare)",
  "    • Hepatotoxicity — cholestatic pattern (vs PTU which causes hepatocellular); monitor LFTs",
  "    • Vasculitis (ANCA-positive)",
  "    • Hypothyroidism — if overdosed (monitor TSH every 4–6 weeks)",
  "    • Insulin autoimmune syndrome (rare — hypoglycemia due to anti-insulin antibodies)",
  "",
  "⚠ Patients must report: sore throat, fever, mouth sores, or jaundice IMMEDIATELY",
], { fontSize: 13.5 });

// ══════════════════════════════════════════════
// SLIDE 9 – METHIMAZOLE: CONTRAINDICATIONS
// ══════════════════════════════════════════════
addSlide("Methimazole — Contraindications", [
  "ABSOLUTE CONTRAINDICATIONS:",
  "    • Previous agranulocytosis caused by methimazole or carbimazole",
  "    • Severe hepatic impairment",
  "    • Known hypersensitivity to the drug",
  "",
  "RELATIVE CONTRAINDICATIONS:",
  "    • Pregnancy — especially FIRST TRIMESTER (teratogenic: associated with aplasia cutis, choanal atresia, MMI embryopathy)",
  "    • Breastfeeding (excreted in breast milk; PTU preferred if must treat — MMI at low doses <20 mg/day may be acceptable under close monitoring)",
  "    • Severe leukopenia or thrombocytopenia at baseline",
  "",
  "SPECIAL NOTES:",
  "    • In pregnancy: Use PTU in 1st trimester → switch to MMI in 2nd/3rd trimester (PTU risk of liver failure in later pregnancy)",
  "    • Monitor CBC before and during therapy",
  "    • Do NOT use in thyroid storm when PTU is preferred (PTU also blocks T4→T3 conversion)",
], { fontSize: 14 });

// ══════════════════════════════════════════════
// SLIDE 10 – PTU: MOA & PHARMACOKINETICS
// ══════════════════════════════════════════════
addSlide("Propylthiouracil (PTU) — Mechanism of Action", [
  "PRIMARY MOA: Inhibits thyroid peroxidase (TPO) → blocks organification and coupling reactions (same as MMI)",
  "UNIQUE ADDITIONAL MOA: Inhibits peripheral deiodinase (Type 1) → blocks conversion of T4 → T3",
  "    • This makes PTU faster at reducing active T3 levels — valuable in thyroid storm",
  "Does NOT block iodide uptake by the NIS transporter",
  "Highly protein bound (~75–80%) → less crosses the placenta and into breast milk compared to MMI",
  "Oral bioavailability: ~80% | Half-life: 1–2 hours (short → requires multiple daily doses)",
  "Intrathyroidal half-life is longer than plasma half-life, but shorter than methimazole",
], { fontSize: 15 });

// ══════════════════════════════════════════════
// SLIDE 11 – PTU: DOSAGE, ONSET, DURATION
// ══════════════════════════════════════════════
addSlide("Propylthiouracil (PTU) — Dosage, Onset & Duration", [
  "DOSAGE:",
  "    • Initial (mild-moderate): 100–150 mg every 8 hours (300–450 mg/day in 3 divided doses)",
  "    • Severe/Thyroid storm: 200–250 mg every 4–6 hours (600–1000 mg/day)",
  "    • Maintenance: 50–150 mg once or twice daily",
  "    • Pediatric: 5–10 mg/kg/day in divided doses every 8 hours",
  "",
  "ONSET:",
  "    • Starts reducing T3 synthesis within hours",
  "    • Peripheral T4 → T3 blockade: near-immediate reduction in T3 levels",
  "    • Clinical improvement: 2–4 weeks",
  "    • Euthyroid state: 6–12 weeks",
  "",
  "DURATION:",
  "    • Short plasma half-life (1–2 h) → must be given 3× daily",
  "    • Treatment course: 12–18 months",
  "    • Remission: ~40% after full course",
], { fontSize: 14 });

// ══════════════════════════════════════════════
// SLIDE 12 – PTU: SIDE EFFECTS
// ══════════════════════════════════════════════
addSlide("Propylthiouracil (PTU) — Side Effects", [
  "MINOR (similar to MMI, ~5% of patients):",
  "    • Skin rash, pruritus, urticaria (most common)",
  "    • Arthralgia — may be severe; arthritis-like syndrome reported",
  "    • Nausea, GI upset",
  "    • Alopecia (hair loss)",
  "",
  "MAJOR (serious, relatively more common than MMI):",
  "    • Agranulocytosis (<1%) — sore throat + fever → check CBC, STOP drug",
  "    • HEPATOTOXICITY — most feared: hepatocellular pattern → can cause fulminant hepatic failure (more serious than MMI's cholestatic pattern)",
  "    • Risk of liver failure higher with PTU than MMI — especially with prolonged use",
  "    • Vasculitis (ANCA-positive — anti-MPO) — higher risk than with MMI",
  "    • Hypothyroidism (if overdosed)",
  "    • Lupus-like syndrome (rare)",
  "    • Hypoprothrombinemia (rare — impaired clotting factor synthesis)",
  "",
  "⚠ FDA BLACK BOX WARNING: PTU can cause severe liver injury including liver failure and death",
], { fontSize: 13 });

// ══════════════════════════════════════════════
// SLIDE 13 – PTU: CONTRAINDICATIONS
// ══════════════════════════════════════════════
addSlide("Propylthiouracil (PTU) — Contraindications", [
  "ABSOLUTE CONTRAINDICATIONS:",
  "    • Previous severe hepatic injury caused by PTU",
  "    • Known hypersensitivity to PTU",
  "",
  "RELATIVE CONTRAINDICATIONS:",
  "    • Hepatic impairment (use with extreme caution; hepatotoxicity risk is higher)",
  "    • Leukopenia or bone marrow suppression at baseline",
  "",
  "PREFERRED / SPECIAL SITUATIONS:",
  "    • PREFERRED in 1st trimester of pregnancy (MMI teratogenic in 1st trimester; PTU causes less teratogenicity early on — but monitor LFTs closely)",
  "    • PREFERRED in thyroid storm (due to dual action: blocks synthesis + blocks T4→T3 conversion)",
  "    • Breastfeeding: PTU is preferred over MMI — less concentrated in breast milk; monitor infant thyroid function",
  "",
  "MONITORING REQUIREMENTS:",
  "    • Baseline LFTs before starting; repeat if symptoms of hepatitis develop",
  "    • Advise patients to report jaundice, dark urine, pale stools, or abdominal pain immediately",
], { fontSize: 13.5 });

// ══════════════════════════════════════════════
// SLIDE 14 – COMPARISON TABLE: THIOAMIDES
// ══════════════════════════════════════════════
tableSlide(
  "Thioamide Comparison — Methimazole vs PTU",
  ["Parameter", "Methimazole (MMI)", "Propylthiouracil (PTU)"],
  [
    ["Mechanism", "TPO inhibition → blocks organification & coupling", "TPO inhibition + inhibits peripheral T4→T3 conversion"],
    ["Dosage (initial)", "15–30 mg/day (once daily)", "300–450 mg/day (3× daily)"],
    ["Dosage (maintenance)", "5–15 mg once daily", "50–150 mg once or twice daily"],
    ["Half-life (plasma)", "4–6 hours", "1–2 hours"],
    ["Dosing frequency", "Once daily", "2–3 times daily"],
    ["Onset", "2–4 weeks (clinical)", "2–4 weeks; T3 drops faster"],
    ["Duration of treatment", "12–18 months", "12–18 months"],
    ["Hepatotoxicity", "Cholestatic (rare, less severe)", "Hepatocellular — BLACK BOX WARNING"],
    ["Agranulocytosis", "< 1%", "< 1%"],
    ["Pregnancy (1st trimester)", "AVOID (embryopathy risk)", "PREFERRED"],
    ["Pregnancy (2nd/3rd trimester)", "PREFERRED (switch from PTU)", "Avoid (hepatotoxicity risk)"],
    ["Thyroid storm", "2nd choice", "PREFERRED (blocks T4→T3)"],
    ["Protein binding", "Low (< 10%)", "High (~75–80%)"],
  ],
  { headFs: 14, bodyFs: 11.5, rowH: 0.42, colW: [2.8, 4.5, 5.0] }
);

// ══════════════════════════════════════════════
// SLIDE 15 – SECTION: IODIDES
// ══════════════════════════════════════════════
sectionHeader("Iodides", "Lugol's Iodine · Potassium Iodide (SSKI) · Radioactive ¹³¹I");

// ══════════════════════════════════════════════
// SLIDE 16 – IODIDES MOA, DOSAGE, ONSET, DURATION
// ══════════════════════════════════════════════
addSlide("Iodides (Lugol's / SSKI) — Mechanism, Dosage, Onset, Duration", [
  "MECHANISM OF ACTION:",
  "    • Wolff-Chaikoff Effect: Large doses of iodide paradoxically INHIBIT thyroid hormone synthesis and release (acute block)",
  "    • Inhibit thyroid hormone RELEASE (proteolysis of thyroglobulin) → rapid fall in circulating T3/T4",
  "    • Reduce vascularity of the thyroid gland (important pre-operatively)",
  "    • Block iodide uptake by the NIS (transporter inhibition at high concentrations)",
  "    • Escape from Wolff-Chaikoff effect usually occurs within 10–14 days (gland adapts)",
  "",
  "DOSAGE:",
  "    • Lugol's iodine (5% I + 10% KI): 3–5 drops (0.1–0.3 mL) 3× daily = ~120–360 mg iodine/day",
  "    • SSKI (1 g/mL): 1–5 drops (50–250 mg) 3× daily",
  "    • Pre-operative preparation: Lugol's 5 drops 3×/day for 10–14 days before thyroid surgery",
  "",
  "ONSET: RAPID — hormone release inhibition begins within hours; clinical effect within 1–2 days",
  "DURATION: Effect lasts 10–14 days (escape from Wolff-Chaikoff effect then occurs → cannot be used alone long-term)",
  "USES: Pre-operative preparation, thyroid storm, radiation emergency (KI tablets protect thyroid from radioactive fallout)",
], { fontSize: 13.5 });

// ══════════════════════════════════════════════
// SLIDE 17 – IODIDES: SIDE EFFECTS & CONTRAINDICATIONS
// ══════════════════════════════════════════════
twoColSlide(
  "Iodides — Side Effects & Contraindications",
  "Side Effects",
  [
    "Iodism: metallic taste, burning mouth, sore teeth/gums",
    "Rhinorrhea, excessive salivation ('sneezing')",
    "Soreness and swelling of salivary glands",
    "Gastric irritation — take with food or milk",
    "Acneiform skin rash",
    "Iododerma — severe skin eruptions (rare, with chronic excess)",
    "Thyroid 'escape' — rebound hyperthyroidism if used alone long-term",
    "Hypothyroidism with goiter — especially in patients with underlying thyroid disease",
    "Paradoxical thyrotoxicosis — Jod-Basedow phenomenon (iodine-induced hyperthyroidism in susceptible individuals)",
  ],
  "Contraindications",
  [
    "Iodine hypersensitivity",
    "Dermatitis herpetiformis",
    "Multinodular goiter (risk of Jod-Basedow / iodine-induced hyperthyroidism)",
    "Pulmonary tuberculosis (historical; iodism may worsen secretions)",
    "Pregnancy (long-term use — neonatal hypothyroidism and goiter risk; short-term pre-op use generally acceptable)",
    "Breastfeeding — excreted in milk; limit duration",
    "Hyperkalemia (for potassium iodide formulations)",
    "NOT to be used as sole long-term therapy for hyperthyroidism (escape occurs)",
  ]
);

// ══════════════════════════════════════════════
// SLIDE 18 – RADIOACTIVE IODINE (131I)
// ══════════════════════════════════════════════
addSlide("Radioactive Iodine (¹³¹I) — Mechanism, Dosage, Onset, Duration", [
  "MECHANISM:",
  "    • ¹³¹I is taken up by thyroid follicular cells via NIS (same as normal iodide)",
  "    • Emits beta particles (90%) and gamma rays (10%)",
  "    • Beta radiation causes local ionisation → thyroid cell destruction → reduces functional thyroid tissue",
  "    • Spares surrounding structures (beta particles travel only 0.5–2 mm in tissue)",
  "",
  "DOSAGE:",
  "    • Typical dose: 80–120 µCi/gram of estimated thyroid weight (corrected for 24-h radioiodine uptake)",
  "    • Administered as a single oral dose (solution or capsule)",
  "    • Patients with severe disease pre-treated with MMI/PTU → stop antithyroid drug 2–3 days before ¹³¹I",
  "",
  "ONSET OF EFFECT:",
  "    • Thyroid hormone levels begin to fall in 2–3 weeks",
  "    • Full effect takes 2–3 months; may require repeat dose after 6 months if insufficient response",
  "",
  "DURATION / OUTCOME:",
  "    • Permanent — most patients develop hypothyroidism (often the desired outcome; then manage with levothyroxine)",
  "    • ~80% become hypothyroid within 1 year after treatment",
], { fontSize: 13.5 });

// ══════════════════════════════════════════════
// SLIDE 19 – 131I: SIDE EFFECTS & CONTRAINDICATIONS
// ══════════════════════════════════════════════
twoColSlide(
  "Radioactive Iodine (¹³¹I) — Side Effects & Contraindications",
  "Side Effects",
  [
    "Hypothyroidism — most common (expected outcome; managed with levothyroxine)",
    "Radiation thyroiditis — pain, swelling over thyroid in first 1–2 weeks",
    "Transient worsening of hyperthyroidism in 1st week (hormone release from damaged cells)",
    "Worsening of Graves ophthalmopathy — steroids used prophylactically if eye disease present",
    "Neck swelling and tenderness",
    "Dry mouth / sialadenitis (salivary gland uptake of iodide)",
    "Nausea (uncommon at therapeutic doses)",
    "Long-term: theoretically increased risk of thyroid cancer (data not clearly established); not recommended for children/young women",
    "Very low radiation dose to ovaries/testes; fertility not significantly impaired",
  ],
  "Contraindications",
  [
    "ABSOLUTE: Pregnancy (radiation teratogenicity, fetal thyroid ablation after 10–12 weeks)",
    "ABSOLUTE: Breastfeeding — must stop at least 6 weeks before treatment",
    "Children and adolescents — generally avoided (concerns re: radiation-induced cancer risk)",
    "Active moderate-severe Graves ophthalmopathy (can worsen eye disease — use steroids if must treat)",
    "Large obstructive goiters (surgery preferred)",
    "Unable to comply with radiation safety precautions",
    "Women planning pregnancy — wait at least 6 months after ¹³¹I before conceiving",
  ]
);

// ══════════════════════════════════════════════
// SLIDE 20 – BETA-BLOCKERS AS ADJUNCTS
// ══════════════════════════════════════════════
addSlide("Beta-Blockers — Adjunct Therapy in Hyperthyroidism", [
  "AGENTS USED: Propranolol (most common), atenolol, metoprolol, nadolol",
  "",
  "MECHANISM:",
  "    • Block β-adrenergic receptors → reduce adrenergically mediated symptoms",
  "    • Propranolol at high doses (≥160 mg/day) also inhibits peripheral T4 → T3 conversion (via deiodinase inhibition)",
  "    • Do NOT reduce thyroid hormone synthesis — purely symptomatic",
  "",
  "DOSAGE:",
  "    • Propranolol: 20–40 mg 3–4× daily (or 80–160 mg once daily for long-acting formulation)",
  "    • Atenolol: 25–100 mg once daily (preferred in elderly/asthma-prone — cardioselective)",
  "",
  "ONSET: Within 30–60 minutes orally; very rapid symptom relief",
  "DURATION: As long as treatment continues; not a definitive treatment",
  "",
  "SIDE EFFECTS: Bradycardia, hypotension, fatigue, cold extremities, bronchoconstriction (non-selective agents)",
  "",
  "CONTRAINDICATIONS: Asthma / COPD (non-selective agents), AV block, decompensated heart failure, severe bradycardia",
  "USES: Control of tachycardia, tremor, anxiety, palpitations, heat intolerance; pre-operative prep; thyroid storm adjunct",
], { fontSize: 13 });

// ══════════════════════════════════════════════
// SLIDE 21 – OVERALL COMPARISON TABLE
// ══════════════════════════════════════════════
tableSlide(
  "Anti-Thyroid Drug Overview — All Classes",
  ["Drug / Class", "Main Mechanism", "Initial Dose", "Onset (Clinical)", "Duration of Use"],
  [
    ["Methimazole", "TPO inhibition → blocks T4/T3 synthesis", "15–30 mg/day (once daily)", "2–4 weeks", "12–18 months"],
    ["Carbimazole", "Pro-drug → converted to methimazole", "20–40 mg/day (equiv to MMI)", "2–4 weeks", "12–18 months"],
    ["PTU", "TPO inhibition + blocks T4→T3 conversion", "300–450 mg/day (3× daily)", "2–4 weeks (T3 drops faster)", "12–18 months"],
    ["Lugol's Iodine / SSKI", "Wolff-Chaikoff: ↓ synthesis & release; ↓ vascularity", "5 drops Lugol's 3×/day", "Hours to 1–2 days", "10–14 days only"],
    ["¹³¹I (Radioiodine)", "Beta radiation → thyroid cell ablation", "80–120 µCi/g tissue (single dose)", "2–3 weeks (full effect 2–3 months)", "Permanent"],
    ["Propranolol / Beta-blockers", "β-blockade → controls adrenergic symptoms; propranolol inhibits T4→T3", "20–40 mg 3–4×/day (propranolol)", "30–60 minutes", "Symptomatic use (weeks to months)"],
  ],
  { headFs: 13, bodyFs: 11, rowH: 0.72, colW: [2.2, 3.2, 2.6, 2.2, 2.6] }
);

// ══════════════════════════════════════════════
// SLIDE 22 – SECTION HEADER: HYPOTHYROIDISM
// ══════════════════════════════════════════════
sectionHeader("Hypothyroidism", "Deficiency of thyroid hormones → slowing of all body functions");

// ══════════════════════════════════════════════
// SLIDE 23 – SIGNS & SYMPTOMS OF HYPOTHYROIDISM
// ══════════════════════════════════════════════
twoColSlide(
  "Signs & Symptoms of Hypothyroidism",
  "SYMPTOMS (Subjective)",
  [
    "Fatigue, lethargy, sleepiness",
    "Mental impairment, depression, 'brain fog'",
    "Cold intolerance (feel cold all the time)",
    "Weight gain despite decreased appetite",
    "Constipation (decreased gut motility)",
    "Dry skin, hair loss (alopecia)",
    "Decreased perspiration (anhidrosis)",
    "Hoarseness of voice",
    "Arthralgia, myalgia",
    "Paresthesia (numbness/tingling)",
    "Menstrual disturbances (menorrhagia, oligomenorrhea) and infertility",
    "Decreased libido",
  ],
  "SIGNS (Objective)",
  [
    "Goiter (may or may not be present depending on etiology)",
    "Bradycardia (slow pulse)",
    "Dry, rough, cool skin",
    "Non-pitting edema / myxedema (glycosaminoglycan deposition)",
    "Loss of outer 1/3 of eyebrow (madarosis)",
    "Puffy face, periorbital edema",
    "Slow speech and movements",
    "Hoarse, croaky voice",
    "Hyporeflexia with delayed relaxation of reflexes (hallmark sign)",
    "Carpal tunnel syndrome",
    "Myopathy, muscle weakness",
    "Bradycardia; diastolic hypertension",
    "Congestive cardiac failure (severe hypothyroidism)",
    "Psychosis ('myxedema madness') in extreme cases",
    "Growth failure + mental retardation (congenital — undetected cretinism)",
  ]
);

// ══════════════════════════════════════════════
// SLIDE 24 – HYPOTHYROIDISM: ADDITIONAL DETAILS
// ══════════════════════════════════════════════
addSlide("Hypothyroidism — Key Clinical Features by System", [
  "CARDIOVASCULAR: Bradycardia, diastolic hypertension (increased peripheral vascular resistance); cardiac output reduced 30–50%; pericardial effusion; dyslipidemia (↑LDL, ↑total cholesterol)",
  "METABOLIC: Weight gain, hyperlipidaemia, hyponatremia (SIADH-like), hypoglycemia (in severe cases)",
  "NEUROLOGICAL: Slow mentation, depression, psychosis (myxedema madness), cerebellar ataxia (rare), peripheral neuropathy",
  "MUSCULOSKELETAL: Myopathy, ↑CK levels, carpal tunnel syndrome, arthralgia",
  "RESPIRATORY: Pleural effusion, hypoventilation, sleep apnea (macroglossia, hypopharyngeal deposition)",
  "GI: Constipation; megacolon in severe cases; ascites (rare)",
  "REPRODUCTIVE: Menorrhagia, anovulation, infertility; hyperprolactinemia → galactorrhea",
  "DERMATOLOGICAL: Dry skin, myxedema, coarse hair, alopecia, loss of lateral eyebrow",
  "LABORATORY: ↑TSH (primary), ↓free T4, normocytic or macrocytic anemia, ↑total cholesterol, ↑CK",
  "SEVERE / EMERGENCY: Myxedema coma — hypothermia, hypoventilation, altered consciousness, hypotension → LIFE-THREATENING",
], { fontSize: 13.5 });

// ══════════════════════════════════════════════
// SLIDE 25 – SECTION HEADER: HYPERTHYROIDISM
// ══════════════════════════════════════════════
sectionHeader("Hyperthyroidism", "Excess thyroid hormones → acceleration of all body functions");

// ══════════════════════════════════════════════
// SLIDE 26 – SIGNS & SYMPTOMS OF HYPERTHYROIDISM
// ══════════════════════════════════════════════
twoColSlide(
  "Signs & Symptoms of Hyperthyroidism",
  "SYMPTOMS (Subjective)",
  [
    "Palpitations, rapid heartbeat",
    "Heat intolerance, excessive sweating",
    "Weight loss despite increased appetite (hypermetabolism)",
    "Anxiety, nervousness, irritability, emotional lability",
    "Tremor of hands (fine tremor)",
    "Fatigue and muscle weakness (proximal myopathy)",
    "Insomnia, restlessness, hyperactivity",
    "Increased bowel frequency (hyperdefecation)",
    "Diarrhea (severe cases)",
    "Oligo/amenorrhea; reduced fertility",
    "Decreased libido; erectile dysfunction",
    "Dyspnea on exertion, exercise intolerance",
  ],
  "SIGNS (Objective)",
  [
    "Tachycardia (resting HR >100 bpm) — most consistent sign",
    "Atrial fibrillation (especially elderly patients)",
    "Systolic hypertension with widened pulse pressure",
    "Lid lag and lid retraction (von Graefe's sign / Dalrymple's sign)",
    "Exophthalmos / proptosis (Graves disease)",
    "Fine tremor of outstretched hands",
    "Warm, moist, smooth skin",
    "Diffuse goiter (Graves) or nodular goiter",
    "Thyroid bruit (Graves disease — increased vascularity)",
    "Pretibial myxedema (Graves disease)",
    "Thyroid acropachy (rare — Graves)",
    "Brisk hyperreflexia",
    "Proximal muscle weakness (difficulty rising from chair)",
    "Onycholysis (nail separation — Plummer's nails)",
    "Gynecomastia (men — peripheral androgen→estrogen conversion)",
  ]
);

// ══════════════════════════════════════════════
// SLIDE 27 – HYPERTHYROIDISM: SYSTEM-BY-SYSTEM
// ══════════════════════════════════════════════
addSlide("Hyperthyroidism — Key Clinical Features by System", [
  "CARDIOVASCULAR: Tachycardia, atrial fibrillation, systolic hypertension, widened pulse pressure, high-output heart failure; increased cardiac oxygen demand",
  "METABOLIC: Weight loss, hyperglycemia (increased GI absorption + insulin resistance), hypercalcemia; increased BMR",
  "NEUROPSYCHIATRIC: Anxiety, tremor, hyperreflexia, psychosis (rare); myopathy; Wernicke-like encephalopathy in extreme cases",
  "GI: Hyperdefecation, weight loss, nausea; elevated liver enzymes (mild) → jaundice/liver failure in severe thyrotoxicosis",
  "OPHTHALMOLOGICAL (Graves): Exophthalmos, proptosis, periorbital oedema, chemosis, diplopia; corneal ulceration if severe",
  "REPRODUCTIVE: Oligomenorrhea / amenorrhea, reduced fertility; in men: premature ejaculation (50%), gynecomastia",
  "HAEMATOLOGICAL: Mild normocytic anemia, relative lymphocytosis, hypercoagulable state",
  "RENAL: Increased GFR and renal blood flow; polyuria, polydipsia; hypomagnesemia",
  "DERMATOLOGY: Warm moist skin, fine hair, onycholysis, pretibial myxedema (Graves-specific)",
  "EMERGENCY — THYROID STORM: Hyperthermia (>40°C), extreme tachycardia, AF, altered consciousness, vomiting, diarrhea → mortality up to 20–30%; diagnose clinically (Burch-Wartofsky score)",
], { fontSize: 13.5 });

// ══════════════════════════════════════════════
// SLIDE 28 – HYPOTHYROIDISM vs HYPERTHYROIDISM COMPARISON
// ══════════════════════════════════════════════
tableSlide(
  "Hypothyroidism vs Hyperthyroidism — Quick Comparison",
  ["Feature", "Hypothyroidism", "Hyperthyroidism"],
  [
    ["Metabolism / BMR", "↓ Decreased (slowed)", "↑ Increased (accelerated)"],
    ["Weight", "Weight GAIN", "Weight LOSS (despite ↑appetite)"],
    ["Heart Rate", "Bradycardia (<60 bpm)", "Tachycardia (>100 bpm); AF"],
    ["Temperature tolerance", "Cold intolerance", "Heat intolerance"],
    ["Skin", "Dry, coarse, cool; myxedema", "Warm, moist, smooth"],
    ["Hair", "Coarse, brittle, alopecia", "Fine, soft; hair loss possible"],
    ["Reflexes", "Hyporeflexia; DELAYED relaxation", "Hyperreflexia; brisk"],
    ["Mental state", "Slow, depressed, foggy", "Anxious, irritable, nervous"],
    ["Bowels", "Constipation", "Diarrhea / hyperdefecation"],
    ["Perspiration", "Decreased (anhidrosis)", "Increased (hyperhidrosis)"],
    ["Menstrual cycle", "Menorrhagia (heavy periods)", "Oligomenorrhea / amenorrhea"],
    ["Eyes", "Periorbital puffiness", "Exophthalmos (Graves), lid lag"],
    ["TSH", "↑ High (primary hypothyroid)", "↓ Low / suppressed"],
    ["T4 / T3", "Low free T4/T3", "High free T4/T3 (or T3 alone)"],
    ["Emergency", "Myxedema coma", "Thyroid storm"],
  ],
  { headFs: 13, bodyFs: 11, rowH: 0.42, colW: [2.8, 4.8, 5.2] }
);

// ══════════════════════════════════════════════
// SLIDE 29 – CLINICAL PEARLS
// ══════════════════════════════════════════════
addSlide("Clinical Pearls & Key Take-Aways", [
  "MMI is PREFERRED over PTU for most patients (once-daily dosing, lower hepatotoxicity risk) — exception: 1st trimester pregnancy and thyroid storm",
  "PTU is PREFERRED in: 1st trimester pregnancy | Thyroid storm (dual mechanism: blocks synthesis + T4→T3 conversion)",
  "In pregnancy: PTU (1st trimester) → switch to MMI (2nd/3rd trimester) to reduce overall risk to mother and fetus",
  "Agranulocytosis warning: BOTH thioamides can cause agranulocytosis (<1%) — educate patients: sore throat + fever → STOP drug, get CBC STAT",
  "Iodides (Lugol's/SSKI): useful for PRE-OP prep and thyroid storm; use for only 10–14 days (escape from Wolff-Chaikoff occurs); NEVER use as sole long-term therapy",
  "¹³¹I: preferred for most adult patients >21 yrs; absolutely contraindicated in pregnancy and active breastfeeding; most patients become hypothyroid → long-term levothyroxine needed",
  "Beta-blockers: give RAPID symptomatic relief (30–60 min); do NOT reduce thyroid hormone levels — always combine with definitive therapy",
  "Myxedema coma (hypothyroid emergency): IV levothyroxine + IV hydrocortisone + supportive care",
  "Thyroid storm (hyperthyroid emergency): PTU + Lugol's (give 1 hour AFTER PTU) + propranolol + hydrocortisone + supportive care",
  "KEY LAB: TSH is the MOST SENSITIVE test for thyroid dysfunction; free T4 and free T3 confirm severity",
], { fontSize: 13.5 });

// ══════════════════════════════════════════════
// SLIDE 30 – THANK YOU / REFERENCES
// ══════════════════════════════════════════════
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    { text: "1. Katzung BG. Basic and Clinical Pharmacology, 16th Edition. Chapter 38: Thyroid & Antithyroid Drugs.", options: { breakLine: true } },
    { text: "2. Tietz Textbook of Laboratory Medicine, 7th Edition. Chapter 57: Thyroid Disorders.", options: { breakLine: true } },
    { text: "3. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th Edition. Thyroid and Antithyroid Drugs.", options: { breakLine: true } },
    { text: "4. Goldman-Cecil Medicine International Edition. Antithyroid Drugs.", options: { breakLine: true } },
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// ─── WRITE FILE ───────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/antithyroid-ppt/Anti_Thyroid_Drugs.pptx" })
  .then(() => console.log("SUCCESS: Anti_Thyroid_Drugs.pptx written"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/antithyroid-ppt && node build.js

ls -lh /home/daytona/workspace/antithyroid-ppt/Anti_Thyroid_Drugs.pptx