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.oxml.ns import qn
from lxml import etree
from io import BytesIO

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)

blank = prs.slide_layouts[6]

# Color palette
DARK_BLUE   = RGBColor(0x0D, 0x47, 0xA1)   # deep blue header
TEAL        = RGBColor(0x00, 0x89, 0x7B)   # teal accent
LIGHT_TEAL  = RGBColor(0xB2, 0xDF, 0xDB)   # light teal bg for cells
LIGHT_BLUE  = RGBColor(0xE3, 0xF2, 0xFD)   # slide background
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
DARK_GRAY   = RGBColor(0x21, 0x21, 0x21)
MED_GRAY    = RGBColor(0x55, 0x55, 0x55)
ACCENT_RED  = RGBColor(0xC6, 0x28, 0x28)
AMBER       = RGBColor(0xFF, 0x8F, 0x00)
HEADING_BG  = RGBColor(0x1A, 0x23, 0x7E)   # indigo dark for header bars


def set_bg(slide, color):
    """Fill slide background with a solid color."""
    background = slide.background
    fill = background.fill
    fill.solid()
    fill.fore_color.rgb = color


def add_rect(slide, x, y, w, h, fill_color, line_color=None, line_width=Pt(0)):
    shape = slide.shapes.add_shape(
        1,  # MSO_SHAPE_TYPE.RECTANGLE
        Inches(x), Inches(y), Inches(w), Inches(h)
    )
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    if line_color:
        shape.line.color.rgb = line_color
        shape.line.width = line_width
    else:
        shape.line.fill.background()
    return shape


def add_text(slide, text, x, y, w, h, font_size, bold=False, color=DARK_GRAY,
             align=PP_ALIGN.LEFT, italic=False, wrap=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb


def add_bullet_box(slide, items, x, y, w, h, font_size=13, title=None,
                   title_color=DARK_BLUE, bullet_color=DARK_GRAY, bg_color=None,
                   title_size=14):
    if bg_color:
        add_rect(slide, x, y, w, h, bg_color)
    if title:
        add_text(slide, title, x+0.05, y+0.05, w-0.1, 0.32,
                 title_size, bold=True, color=title_color)
        start_y = y + 0.38
        box_h = h - 0.38
    else:
        start_y = y + 0.05
        box_h = h - 0.1

    tb = slide.shapes.add_textbox(
        Inches(x+0.1), Inches(start_y), Inches(w-0.2), Inches(box_h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Pt(2)
    tf.margin_right = Pt(2)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    for i, item in enumerate(items):
        if i == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        p.text = f"\u2022  {item}"
        p.space_before = Pt(3)
        p.space_after = Pt(2)
        for run in p.runs:
            run.font.size = Pt(font_size)
            run.font.color.rgb = bullet_color
            run.font.name = "Calibri"
    return tb


def header_bar(slide, title, subtitle=None):
    """Add a dark header bar at the top of a content slide."""
    add_rect(slide, 0, 0, 13.333, 1.1, HEADING_BG)
    add_text(slide, title, 0.3, 0.1, 12.5, 0.6,
             28, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_text(slide, subtitle, 0.3, 0.65, 12.5, 0.38,
                 14, color=RGBColor(0xBB, 0xDE, 0xFB), align=PP_ALIGN.LEFT)
    # teal accent line
    add_rect(slide, 0, 1.08, 13.333, 0.06, TEAL)


def footer(slide, text="Hypothyroid Drugs | Pharmacology"):
    add_rect(slide, 0, 7.2, 13.333, 0.3, HEADING_BG)
    add_text(slide, text, 0.3, 7.2, 12.5, 0.3,
             10, color=RGBColor(0xBB, 0xDE, 0xFB), align=PP_ALIGN.LEFT)


# ─────────────────────────────────────────────
# SLIDE 1 – Title Slide
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xE8, 0xEA, 0xF6))

# Big dark band
add_rect(slide, 0, 1.5, 13.333, 3.5, HEADING_BG)
add_rect(slide, 0, 4.95, 13.333, 0.1, TEAL)

add_text(slide, "HYPOTHYROID DRUGS", 0.5, 1.7, 12.3, 1.2,
         44, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_text(slide, "Mechanism of Action  |  Onset & Duration  |  Side Effects",
         0.5, 2.9, 12.3, 0.8, 20, color=RGBColor(0xBB, 0xDE, 0xFB),
         align=PP_ALIGN.CENTER)
add_text(slide, "Pharmacology Reference — Lippincott & Goodman & Gilman",
         0.5, 3.7, 12.3, 0.55, 13,
         color=RGBColor(0xCC, 0xCC, 0xCC), align=PP_ALIGN.CENTER)

# decorative teal squares
for xi in [0.5, 1.1, 1.7]:
    add_rect(slide, xi, 5.2, 0.45, 0.45, TEAL)
add_rect(slide, 0.5, 5.8, 1.7, 0.08, TEAL)

add_text(slide, "Prepared for Educational Use", 0.5, 6.5, 12.3, 0.5,
         12, color=MED_GRAY, align=PP_ALIGN.CENTER, italic=True)

# ─────────────────────────────────────────────
# SLIDE 2 – Overview of Thyroid Axis
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Thyroid Axis & Hypothyroidism",
           "Understanding the feedback axis is key to drug targeting")
footer(slide)

add_rect(slide, 0.3, 1.25, 12.7, 5.75, WHITE,
         line_color=RGBColor(0xDD, 0xDD, 0xDD), line_width=Pt(1))

# Left: Axis box
add_rect(slide, 0.5, 1.45, 5.5, 4.9, RGBColor(0xE8, 0xF5, 0xE9))
add_text(slide, "HPT Axis (Normal)", 0.55, 1.5, 5.4, 0.4, 15,
         bold=True, color=TEAL)

axis_steps = [
    "1.  Hypothalamus secretes TRH (thyrotropin-releasing hormone)",
    "2.  Anterior pituitary releases TSH (thyroid-stimulating hormone)",
    "3.  TSH stimulates thyroid → synthesis & release of T3 and T4",
    "4.  T3/T4 exert negative feedback on hypothalamus & pituitary",
    "5.  T4 (thyroxine) is peripheral reservoir → converted to active T3",
]
add_bullet_box(slide, axis_steps, 0.5, 1.95, 5.5, 3.5, font_size=12,
               bullet_color=DARK_GRAY)

# Right: Hypothyroidism
add_rect(slide, 6.3, 1.45, 6.3, 2.3, RGBColor(0xFF, 0xEB, 0xEE))
add_text(slide, "Hypothyroidism — Features", 6.35, 1.5, 6.2, 0.4, 15,
         bold=True, color=ACCENT_RED)
hypo_feat = [
    "Elevated TSH (most sensitive marker)",
    "Low free T4 / T3",
    "Bradycardia, cold intolerance, weight gain",
    "Fatigue, constipation, dry skin",
    "Myxedema in severe cases; cretinism if congenital",
]
add_bullet_box(slide, hypo_feat, 6.3, 1.95, 6.3, 1.75, font_size=12,
               bullet_color=DARK_GRAY)

# Right-bottom: Causes
add_rect(slide, 6.3, 3.85, 6.3, 2.0, RGBColor(0xFFF, 0xF8, 0xE1))
add_rect(slide, 6.3, 3.85, 6.3, 2.0, RGBColor(0xFF, 0xF9, 0xC4))
add_text(slide, "Common Causes", 6.35, 3.9, 6.2, 0.4, 15,
         bold=True, color=AMBER)
causes = [
    "Hashimoto's thyroiditis (autoimmune — most common)",
    "Post-radioiodine / post-surgical",
    "Iodine deficiency",
    "Drugs: amiodarone, lithium, interferon",
    "Central (hypothalamic/pituitary) — rare",
]
add_bullet_box(slide, causes, 6.3, 4.35, 6.3, 1.45, font_size=12,
               bullet_color=DARK_GRAY)

# ─────────────────────────────────────────────
# SLIDE 3 – Drug Classification
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Classification of Drugs Used in Hypothyroidism",
           "Replacement therapy is primary; adjuncts address specific situations")
footer(slide)

classes = [
    ("THYROID HORMONE REPLACEMENT\n(PRIMARY THERAPY)",
     DARK_BLUE,
     RGBColor(0xE3, 0xF2, 0xFD),
     ["Levothyroxine (T4) — first-line", "Liothyronine (T3)", "Liotrix (T3 + T4 combo)", "Desiccated thyroid extract (historical/alt)"]),
    ("ADJUNCT / SPECIAL SITUATIONS",
     TEAL,
     RGBColor(0xE0, 0xF2, 0xF1),
     ["β-Blockers (propranolol) — for symptoms in thyroid storm", "Iodide supplements (severe deficiency)", "Selenium supplementation", "Vitamin D (associated deficiency)"]),
    ("DRUGS CAUSING HYPOTHYROIDISM\n(Awareness — not treatment)",
     ACCENT_RED,
     RGBColor(0xFF, 0xEB, 0xEE),
     ["Amiodarone (iodine-rich)", "Lithium (inhibits thyroid secretion)", "Interferon-alpha", "Thioamides (PTU, methimazole) — when over-treated"]),
]

x_positions = [0.4, 4.65, 8.9]
for i, (title, title_col, bg_col, items) in enumerate(classes):
    x = x_positions[i]
    add_rect(slide, x, 1.25, 4.1, 5.85, bg_col,
             line_color=title_col, line_width=Pt(1.5))
    add_rect(slide, x, 1.25, 4.1, 0.7, title_col)
    add_text(slide, title, x+0.1, 1.28, 3.9, 0.65,
             11.5, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_bullet_box(slide, items, x, 1.98, 4.1, 4.4,
                   font_size=12.5, bullet_color=DARK_GRAY)

# ─────────────────────────────────────────────
# SLIDE 4 – Levothyroxine (T4)
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Levothyroxine (T4)  —  First-Line Drug",
           "Synthetic L-thyroxine · Most widely prescribed thyroid preparation")
footer(slide)

# 4 info boxes
boxes = [
    ("MECHANISM OF ACTION", DARK_BLUE, RGBColor(0xE3, 0xF2, 0xFD),
     ["Synthetic form of T4 — identical to endogenous thyroxine",
      "Absorbed orally → distributed to peripheral tissues",
      "Converted to active T3 by 5'-deiodinase in liver, kidney, and periphery",
      "T3 enters the nucleus → binds thyroid hormone receptors (TRα, TRβ)",
      "Activates gene transcription → raises basal metabolic rate",
      "Stimulates protein synthesis, cardiac output, CNS development",
      "Exerts negative feedback on TSH and TRH"]),
    ("ONSET & DURATION", TEAL, RGBColor(0xE0, 0xF2, 0xF1),
     ["Oral bioavailability: ~70–80% (take on empty stomach)",
      "Onset of effect: 3–5 days (T4 half-life ~7 days)",
      "Symptom improvement: within 2–4 weeks",
      "Steady state: achieved in ~6–8 weeks",
      "Duration of action: 1–2 weeks after last dose",
      "TSH should be re-checked 6–8 weeks post-initiation or dose change",
      "Dose: individualized; usual 1.6 mcg/kg/day"]),
    ("SIDE EFFECTS / TOXICITY", ACCENT_RED, RGBColor(0xFF, 0xEB, 0xEE),
     ["Toxicity mirrors hyperthyroidism (from over-replacement):",
      "Palpitations, tachycardia, arrhythmia (AF risk in elderly)",
      "Heat intolerance, excessive sweating",
      "Weight loss, increased appetite",
      "Tremors, anxiety, insomnia, irritability",
      "Osteoporosis with prolonged over-treatment",
      "Angina in patients with CAD (start low, go slow)"]),
    ("DRUG INTERACTIONS & NOTES", AMBER, RGBColor(0xFF, 0xF9, 0xC4),
     ["Absorption reduced by: Ca²⁺, Fe²⁺, Al³⁺ antacids, food (take 30 min before meals)",
      "Metabolism increased by: phenytoin, rifampin, phenobarbital (CYP450 inducers)",
      "Cholestyramine reduces absorption — separate by 4 h",
      "Warfarin sensitivity increased — monitor INR",
      "Avoid biotin supplements at time of TSH testing (false results)",
      "Pregnancy: dose requirement increases ~30–50%"]),
]

positions = [(0.3, 1.2, 6.4, 5.9), (6.85, 1.2, 6.15, 5.9),
             (0.3, 4.1, 6.4, 3.0), (6.85, 4.1, 6.15, 3.0)]

for (title, title_col, bg_col, items), (x, y, w, h) in zip(boxes[:2], positions[:2]):
    add_rect(slide, x, y, w, h, bg_col,
             line_color=title_col, line_width=Pt(1.2))
    add_rect(slide, x, y, w, 0.45, title_col)
    add_text(slide, title, x+0.1, y+0.04, w-0.2, 0.38,
             12, bold=True, color=WHITE)
    add_bullet_box(slide, items, x, y+0.48, w, h-0.55,
                   font_size=11.5, bullet_color=DARK_GRAY)

# ─────────────────────────────────────────────
# SLIDE 5 – Liothyronine (T3) & Liotrix
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Liothyronine (T3) & Liotrix (T3/T4 Combination)",
           "Alternative thyroid hormone preparations")
footer(slide)

# Liothyronine box LEFT
add_rect(slide, 0.3, 1.25, 6.2, 5.9, RGBColor(0xE8, 0xF5, 0xE9),
         line_color=TEAL, line_width=Pt(1.5))
add_rect(slide, 0.3, 1.25, 6.2, 0.5, TEAL)
add_text(slide, "LIOTHYRONINE (T3)  —  Cytomel", 0.4, 1.28, 6.0, 0.45,
         14, bold=True, color=WHITE)

t3_sections = [
    ("Mechanism of Action:",
     ["Synthetic T3 — the biologically active form",
      "Directly binds nuclear thyroid hormone receptors (TRα, TRβ)",
      "No conversion required (unlike T4 → T3 conversion step)",
      "Activates gene transcription → metabolic effects faster than T4"]),
    ("Onset & Duration:",
     ["Rapid onset: within 2–4 hours of oral dose",
      "Peak effect: 2–3 days",
      "Half-life: ~1 day (much shorter than T4)",
      "Duration: short; requires 2–3x daily dosing",
      "Steady state: 1–2 weeks"]),
    ("Side Effects:",
     ["Greater cardiovascular risk than T4 (rapid T3 surges)",
      "Palpitations, angina, arrhythmias",
      "Anxiety, insomnia, sweating, weight loss",
      "Harder to maintain stable levels than T4",
      "NOT preferred for routine hypothyroidism"]),
    ("Indications:",
     ["Myxedema coma (IV form — rapid action needed)",
      "Thyroid suppression testing",
      "Patients with T4-to-T3 conversion defects",
      "Some adjunct use in refractory depression"]),
]

y_pos = 1.85
for sec_title, items in t3_sections:
    add_text(slide, sec_title, 0.4, y_pos, 6.0, 0.3, 12,
             bold=True, color=TEAL)
    add_bullet_box(slide, items, 0.4, y_pos+0.3, 6.0, len(items)*0.28+0.1,
                   font_size=11, bullet_color=DARK_GRAY)
    y_pos += len(items)*0.28 + 0.48

# Liotrix box RIGHT
add_rect(slide, 6.85, 1.25, 6.15, 5.9, RGBColor(0xFFF, 0xF8, 0xE1),
         line_color=AMBER, line_width=Pt(1.5))
add_rect(slide, 6.85, 1.25, 6.15, 0.5, AMBER)
add_text(slide, "LIOTRIX (T3 + T4 COMBO)  —  Thyrolar", 6.95, 1.28, 5.95, 0.45,
         13, bold=True, color=WHITE)

liotrix_data = [
    ("What is it?",
     ["Fixed ratio combination of T3:T4 = 1:4",
      "Attempts to mimic physiological hormone secretion",
      "Contains both T4 (slow) and T3 (fast-acting) components"]),
    ("Mechanism:",
     ["Combined nuclear receptor activation by both T3 and T4",
      "T4 component provides sustained baseline effect",
      "T3 component provides rapid onset supplementation"]),
    ("Onset & Duration:",
     ["Onset: faster than levothyroxine alone (T3 component)",
      "Duration: intermediate — daily dosing",
      "Steady state: ~1–2 weeks"]),
    ("Side Effects:",
     ["Greater CV risk vs. levothyroxine alone",
      "T3 peaks can cause palpitations, anxiety",
      "Difficult to fine-tune dosing"]),
    ("Current Status:",
     ["Rarely preferred over levothyroxine monotherapy",
      "No consistent evidence of superiority in RCTs",
      "May suit patients with persistent symptoms on T4 alone",
      "Desiccated thyroid extract (DTE) similar concept — porcine-derived"]),
]

y_pos = 1.85
for sec_title, items in liotrix_data:
    add_text(slide, sec_title, 6.95, y_pos, 5.95, 0.3, 12,
             bold=True, color=AMBER)
    add_bullet_box(slide, items, 6.95, y_pos+0.3, 5.95, len(items)*0.27+0.1,
                   font_size=11, bullet_color=DARK_GRAY)
    y_pos += len(items)*0.27 + 0.48

# ─────────────────────────────────────────────
# SLIDE 6 – Comparison Table
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Comparative Summary — Hypothyroid Drugs",
           "At-a-glance reference for all major thyroid hormone preparations")
footer(slide)

# Table via shapes
table_data = [
    ["Feature", "Levothyroxine (T4)", "Liothyronine (T3)", "Liotrix (T3+T4)", "Desiccated Thyroid"],
    ["Class", "Synthetic T4", "Synthetic T3", "T3:T4 = 1:4", "Animal-derived (porcine)"],
    ["Mechanism", "T4 → T3 conversion\n→ nuclear TRα/TRβ", "Direct TRα/TRβ activation\n(no conversion needed)", "Both T4 & T3\nnuclear activation", "Both T4 & T3\n+ calcitonin"],
    ["Onset", "3–5 days\n(symptom: 2–4 wks)", "2–4 hours\n(peak: 2–3 days)", "Faster than T4\n(T3 component)", "Similar to liotrix"],
    ["Half-life", "~7 days", "~1 day", "Mixed: ~1d / 7d", "Mixed"],
    ["Duration", "Long (~1–2 wks)", "Short (~24 h)", "Intermediate", "Intermediate"],
    ["Dosing", "Once daily", "2–3× daily", "Once daily", "Once–twice daily"],
    ["Preferred for", "Routine hypothyroidism\n(First-line)", "Myxedema coma\nT4 conversion defect", "Persistent symptoms\non T4 alone", "Patient preference\n(alternative)"],
    ["Side Effects", "Tachycardia, anxiety,\nosteoporosis (excess)", "High CV risk\nArrhythmia, angina", "CV risk from T3\npeaks", "Unpredictable T3\nlevels"],
    ["Monitoring", "TSH (q6–8 wks)", "Free T3, TSH", "TSH + free T3", "TSH + free T3/T4"],
]

col_widths = [1.8, 2.3, 2.3, 2.3, 2.3]
col_colors = [HEADING_BG, RGBColor(0xE3, 0xF2, 0xFD), RGBColor(0xE0, 0xF2, 0xF1),
              RGBColor(0xFF, 0xF9, 0xC4), RGBColor(0xFB, 0xE9, 0xE7)]
header_text_colors = [WHITE, DARK_BLUE, TEAL, AMBER, ACCENT_RED]

start_x = 0.35
row_height = 0.57
start_y = 1.2

for row_i, row in enumerate(table_data):
    x = start_x
    for col_i, cell_text in enumerate(row):
        w = col_widths[col_i]
        if row_i == 0:
            bg = HEADING_BG if col_i == 0 else [DARK_BLUE, TEAL, AMBER, ACCENT_RED][col_i-1]
            tc = WHITE
            fs = 11
            bold = True
        else:
            bg = RGBColor(0xEE, 0xEE, 0xEE) if col_i == 0 else (
                WHITE if row_i % 2 == 0 else col_colors[col_i])
            tc = DARK_GRAY if col_i > 0 else DARK_BLUE
            fs = 10
            bold = col_i == 0

        add_rect(slide, x, start_y + row_i * row_height, w, row_height,
                 bg, line_color=RGBColor(0xBB, 0xBB, 0xBB), line_width=Pt(0.5))
        add_text(slide, cell_text,
                 x+0.04, start_y + row_i * row_height + 0.04,
                 w-0.08, row_height-0.08, fs, bold=bold, color=tc,
                 align=PP_ALIGN.CENTER, wrap=True)
        x += w

# ─────────────────────────────────────────────
# SLIDE 7 – Special Situations
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Special Clinical Situations",
           "Dose adjustments, monitoring, and cautions in key populations")
footer(slide)

situations = [
    ("PREGNANCY", TEAL, RGBColor(0xE0, 0xF2, 0xF1),
     ["T4 requirement increases 30–50% during pregnancy (especially 1st trimester)",
      "Untreated hypothyroidism → fetal neurological impairment, preterm birth",
      "Goal: maintain TSH in trimester-specific ranges (1st trim: 0.1–2.5 mIU/L)",
      "TSH should be monitored every 4 weeks during early pregnancy",
      "IV levothyroxine if unable to take orally (1/2 oral dose)",
      "Postpartum: dose usually returns to pre-pregnancy level"]),
    ("MYXEDEMA COMA", ACCENT_RED, RGBColor(0xFF, 0xEB, 0xEE),
     ["Life-threatening; mortality up to 50% without treatment",
      "IV levothyroxine 200–400 mcg loading dose + 50–100 mcg/day maintenance",
      "OR IV liothyronine (T3): 5–20 mcg; faster onset — preferred by some",
      "Combination T3 + T4 IV often used initially",
      "Concurrent IV hydrocortisone (exclude adrenal insufficiency first)",
      "Supportive: warming, ventilatory support, treat precipitants"]),
    ("ELDERLY PATIENTS", DARK_BLUE, RGBColor(0xE3, 0xF2, 0xFD),
     ["Start at low dose: 12.5–25 mcg/day levothyroxine",
      "Titrate slowly (q4–6 weeks) — higher AF and angina risk",
      "Target TSH may be higher (1–4 mIU/L) in elderly",
      "Osteoporosis risk with over-replacement — monitor bone density",
      "Review for polypharmacy interactions (digoxin, warfarin, Ca²⁺)"]),
    ("CARDIAC DISEASE", AMBER, RGBColor(0xFF, 0xF9, 0xC4),
     ["Start very low: 12.5 mcg/day",
      "Rapid normalization of thyroid function can precipitate angina/MI",
      "Avoid T3 preparations (rapid CV effects)",
      "β-Blockers may be co-administered to control heart rate initially",
      "Goal TSH: within normal range but err slightly on higher side"]),
]

xs = [0.3, 0.3, 6.85, 6.85]
ys = [1.25, 4.15, 1.25, 4.15]
ws = [6.25, 6.25, 6.15, 6.15]
hs = [2.75, 2.75, 2.75, 2.75]

for (title, title_col, bg_col, items), x, y, w, h in zip(situations, xs, ys, ws, hs):
    add_rect(slide, x, y, w, h, bg_col,
             line_color=title_col, line_width=Pt(1.2))
    add_rect(slide, x, y, w, 0.42, title_col)
    add_text(slide, title, x+0.1, y+0.04, w-0.2, 0.38,
             13, bold=True, color=WHITE)
    add_bullet_box(slide, items, x, y+0.45, w, h-0.5,
                   font_size=10.5, bullet_color=DARK_GRAY)

# ─────────────────────────────────────────────
# SLIDE 8 – Side Effects Deep Dive
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Side Effects — Detailed Overview",
           "Effects reflect over-replacement (iatrogenic hyperthyroidism)")
footer(slide)

systems = [
    ("CARDIOVASCULAR", ACCENT_RED,
     ["Tachycardia, palpitations",
      "Atrial fibrillation (especially elderly)",
      "Angina pectoris / worsening IHD",
      "Hypertension", "Cardiac hypertrophy with chronic excess"]),
    ("NEUROLOGICAL / PSYCHIATRIC", DARK_BLUE,
     ["Tremors (fine intentional tremor)",
      "Anxiety, restlessness, irritability",
      "Insomnia", "Headache", "Seizures (rare, very high doses)"]),
    ("MUSCULOSKELETAL", TEAL,
     ["Osteoporosis / decreased BMD (chronic over-treatment)",
      "Muscle weakness, myopathy",
      "Joint pain",
      "Fracture risk increased"]),
    ("METABOLIC / GI", AMBER,
     ["Weight loss, increased appetite",
      "Heat intolerance, diaphoresis",
      "Diarrhea / increased bowel frequency",
      "Menstrual irregularities",
      "Impaired glucose tolerance"]),
    ("PAEDIATRIC / OBSTETRIC", RGBColor(0x6A, 0x1B, 0x9A),
     ["Craniosynostosis with over-treatment in neonates",
      "Advanced bone age in children",
      "Miscarriage / fetal growth restriction if over-dosed",
      "Maternal arrhythmia"]),
    ("UNDER-TREATMENT\n(Residual hypothyroidism)", MED_GRAY,
     ["Persistent fatigue, cognitive slowing",
      "Continued weight gain",
      "Hyperlipidemia",
      "Worsening myxedema",
      "Increased cardiovascular risk"]),
]

x_positions2 = [0.3, 4.65, 8.95]
y_positions2 = [1.25, 1.25, 1.25, 4.35, 4.35, 4.35]
x_pos3 = [0.3, 4.65, 8.95, 0.3, 4.65, 8.95]
widths3 = [4.2, 4.2, 4.1, 4.2, 4.2, 4.1]

for i, (title, col, items) in enumerate(systems):
    x = x_pos3[i]
    y = y_positions2[i]
    w = widths3[i]
    h = 2.9
    bg = RGBColor(0xFF, 0xEB, 0xEE) if col == ACCENT_RED else \
         RGBColor(0xE3, 0xF2, 0xFD) if col == DARK_BLUE else \
         RGBColor(0xE0, 0xF2, 0xF1) if col == TEAL else \
         RGBColor(0xFF, 0xF9, 0xC4) if col == AMBER else \
         RGBColor(0xF3, 0xE5, 0xF5) if col == RGBColor(0x6A, 0x1B, 0x9A) else \
         RGBColor(0xF5, 0xF5, 0xF5)
    add_rect(slide, x, y, w, h, bg, line_color=col, line_width=Pt(1.2))
    add_rect(slide, x, y, w, 0.42, col)
    add_text(slide, title, x+0.08, y+0.03, w-0.15, 0.4, 11.5, bold=True, color=WHITE)
    add_bullet_box(slide, items, x, y+0.44, w, h-0.5, font_size=11,
                   bullet_color=DARK_GRAY)

# ─────────────────────────────────────────────
# SLIDE 9 – Drug Interactions
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Drug Interactions with Thyroid Hormone Preparations",
           "Many common drugs significantly alter thyroid hormone levels")
footer(slide)

# Three columns
int_data = [
    ("REDUCED ABSORPTION\n(Give T4 at least 30 min before / 4h after)", ACCENT_RED,
     RGBColor(0xFF, 0xEB, 0xEE),
     [("Calcium carbonate / Ca²⁺ supplements", "Form insoluble complex with T4"),
      ("Ferrous sulfate (Fe²⁺)", "Chelation → reduced absorption"),
      ("Aluminum hydroxide antacids", "Adsorb T4 in gut"),
      ("Cholestyramine / colestipol", "Bind T4 in intestine"),
      ("Proton pump inhibitors", "Reduce gastric acid needed for absorption"),
      ("Sucralfate", "Physical binding"),
      ("Soy-based formulas (infants)", "Interfere with enteric absorption")]),
    ("INCREASED METABOLISM\n(CYP450 Inducers — may need ↑ T4 dose)", AMBER,
     RGBColor(0xFF, 0xF9, 0xC4),
     [("Rifampin", "Strong CYP3A4 inducer"),
      ("Phenytoin", "Induces CYP450 + displaces T4 from TBG"),
      ("Phenobarbital / carbamazepine", "CYP450 induction"),
      ("Sertraline (SSRIs)", "Accelerate T4 clearance"),
      ("Tyrosine kinase inhibitors\n(imatinib, sunitinib)", "Reduce T4 efficacy"),
      ("Lopinavir/ritonavir (HIV)", "CYP induction")]),
    ("PHARMACODYNAMIC\n& MISCELLANEOUS INTERACTIONS", DARK_BLUE,
     RGBColor(0xE3, 0xF2, 0xFD),
     [("Warfarin", "T4 ↑ catabolism of coag factors → ↑ INR; monitor closely"),
      ("Digoxin", "Hypothyroidism ↑ digoxin toxicity; T4 may need dose adjustment"),
      ("β-Blockers", "Reduce T3/T4 conversion peripherally"),
      ("Amiodarone", "Inhibits T4→T3 conversion; contains iodine"),
      ("Lithium", "Inhibits thyroid secretion → hypothyroidism"),
      ("Estrogen / OCP", "↑ TBG → apparent ↑ T4 need"),
      ("Biotin supplements", "Interfere with TSH immunoassay (falsely low TSH)")]),
]

x_cols = [0.3, 4.7, 9.0]
col_ws = [4.3, 4.2, 4.15]
for i, (title, col, bg, pairs) in enumerate(int_data):
    x = x_cols[i]
    w = col_ws[i]
    h = 5.8
    add_rect(slide, x, 1.25, w, h, bg, line_color=col, line_width=Pt(1.2))
    add_rect(slide, x, 1.25, w, 0.55, col)
    add_text(slide, title, x+0.08, 1.27, w-0.15, 0.52, 11, bold=True, color=WHITE)
    tb = slide.shapes.add_textbox(
        Inches(x+0.12), Inches(1.88), Inches(w-0.22), Inches(h-0.72))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Pt(2)
    tf.margin_top = Pt(2)
    for j, (drug, effect) in enumerate(pairs):
        if j == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        run1 = p.add_run()
        run1.text = f"• {drug}: "
        run1.font.bold = True
        run1.font.size = Pt(10.5)
        run1.font.color.rgb = col
        run1.font.name = "Calibri"
        run2 = p.add_run()
        run2.text = effect
        run2.font.bold = False
        run2.font.size = Pt(10.5)
        run2.font.color.rgb = DARK_GRAY
        run2.font.name = "Calibri"
        p.space_before = Pt(4)
        p.space_after = Pt(2)

# ─────────────────────────────────────────────
# SLIDE 10 – Monitoring & Key Points
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xF5, 0xF5, 0xF5))
header_bar(slide, "Monitoring Parameters & Key Clinical Points",
           "Evidence-based targets and practical management pearls")
footer(slide)

add_rect(slide, 0.3, 1.25, 6.2, 5.9, RGBColor(0xE3, 0xF2, 0xFD),
         line_color=DARK_BLUE, line_width=Pt(1.2))
add_rect(slide, 0.3, 1.25, 6.2, 0.48, DARK_BLUE)
add_text(slide, "MONITORING PARAMETERS", 0.4, 1.28, 6.0, 0.42,
         14, bold=True, color=WHITE)

monitoring = [
    "TSH (Thyroid Stimulating Hormone) — PRIMARY marker",
    "  • Normal range: 0.4 – 4.0 mIU/L (lab-dependent)",
    "  • Check at 6–8 weeks after any dose change",
    "  • Annual monitoring once stable",
    "Free T4 — useful if pituitary disease (central hypothyroidism)",
    "  • Central hypothyroidism: TSH may be low/normal despite low T4",
    "Free T3 — monitor with liothyronine use",
    "Lipid panel — hypothyroidism → hyperlipidemia; improves with T4",
    "Bone mineral density (DEXA) — if prolonged use or elderly",
    "ECG / Holter — if cardiac symptoms develop",
    "CBC — rare thyroid hormone-related anemia",
    "Symptom assessment — fatigue, weight, HR, bowel habits",
    "Anti-TPO antibodies — diagnose Hashimoto's, not routine monitoring",
]

tb = slide.shapes.add_textbox(Inches(0.42), Inches(1.8), Inches(6.0), Inches(5.2))
tf = tb.text_frame
tf.word_wrap = True
for i, item in enumerate(monitoring):
    if i == 0:
        p = tf.paragraphs[0]
    else:
        p = tf.add_paragraph()
    run = p.add_run()
    run.text = item
    run.font.size = Pt(11)
    run.font.name = "Calibri"
    if item.startswith("  •"):
        run.font.color.rgb = MED_GRAY
        run.font.italic = True
        p.space_before = Pt(1)
    else:
        run.font.color.rgb = DARK_GRAY
        run.font.bold = True
        p.space_before = Pt(5)

# Right panel – key points
add_rect(slide, 6.85, 1.25, 6.15, 5.9, RGBColor(0xE8, 0xF5, 0xE9),
         line_color=TEAL, line_width=Pt(1.2))
add_rect(slide, 6.85, 1.25, 6.15, 0.48, TEAL)
add_text(slide, "KEY CLINICAL PEARLS", 6.95, 1.28, 5.95, 0.42,
         14, bold=True, color=WHITE)

pearls = [
    "Always take levothyroxine on empty stomach (30–60 min before breakfast) for consistent absorption",
    "TSH is the best single test — NOT free T4 or T3 alone for routine monitoring",
    "Do NOT check TSH within 6 weeks of a dose change — it lags behind T4 changes",
    "Biotin supplements interfere with TSH assay → stop for 48–72 h before blood draw",
    "In elderly / cardiac patients: START LOW (25 mcg), GO SLOW — re-check in 6–8 weeks",
    "Levothyroxine half-life = 7 days → missing 1–2 doses has minimal clinical impact",
    "T3 (liothyronine) has no role in routine hypothyroidism — reserve for myxedema coma",
    "Subclinical hypothyroidism (elevated TSH, normal T4): treat if TSH > 10 or symptomatic",
    "Thyroid nodules do NOT require TSH suppression therapy unless malignant",
    "Adequate selenium and iodine intake important for thyroid health alongside pharmacotherapy",
]

tb2 = slide.shapes.add_textbox(Inches(6.97), Inches(1.82), Inches(5.93), Inches(5.22))
tf2 = tb2.text_frame
tf2.word_wrap = True
for i, pearl in enumerate(pearls):
    if i == 0:
        p = tf2.paragraphs[0]
    else:
        p = tf2.add_paragraph()
    p.text = f"{i+1}.  {pearl}"
    p.space_before = Pt(5)
    p.space_after = Pt(2)
    for run in p.runs:
        run.font.size = Pt(11)
        run.font.color.rgb = DARK_GRAY
        run.font.name = "Calibri"

# ─────────────────────────────────────────────
# SLIDE 11 – Thank You / References
# ─────────────────────────────────────────────
slide = prs.slides.add_slide(blank)
set_bg(slide, RGBColor(0xE8, 0xEA, 0xF6))

add_rect(slide, 0, 2.0, 13.333, 3.0, HEADING_BG)
add_rect(slide, 0, 4.95, 13.333, 0.12, TEAL)

add_text(slide, "Thank You", 0.5, 2.15, 12.3, 1.1,
         52, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_text(slide, "Questions & Discussion Welcome",
         0.5, 3.2, 12.3, 0.65, 22,
         color=RGBColor(0xBB, 0xDE, 0xFB), align=PP_ALIGN.CENTER)

add_text(slide, "References", 0.5, 5.25, 12.3, 0.4, 14, bold=True, color=DARK_BLUE)
refs = [
    "1.  Brunton LL, Knollmann BC. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th Ed. McGraw-Hill, 2023. Ch. 47.",
    "2.  Whalen K. Lippincott Illustrated Reviews: Pharmacology, 7th Ed. Wolters Kluwer, 2019. Ch. 23.",
    "3.  Harrison's Principles of Internal Medicine, 22nd Ed. McGraw-Hill, 2025.",
    "4.  Tietz Textbook of Laboratory Medicine, 7th Ed. Elsevier, 2023.",
]
add_bullet_box(slide, refs, 0.5, 5.65, 12.3, 1.5,
               font_size=10.5, bullet_color=MED_GRAY)


# ─────────────────────────────────────────────
# SAVE
# ─────────────────────────────────────────────
out_path = "/tmp/workspace/hypothyroid-ppt/Hypothyroid_Drugs_Pharmacology.pptx"
buf = BytesIO()
prs.save(buf)
with open(out_path, "wb") as f:
    f.write(buf.getvalue())

print(f"Saved: {out_path}")
print(f"Total slides: {len(prs.slides)}")