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 pptx.oxml import parse_xml
from lxml import etree
from io import BytesIO

# ---- Color Palette ----
NAVY      = RGBColor(0x1A, 0x3A, 0x5C)   # deep navy (headers, title)
TEAL      = RGBColor(0x00, 0x7B, 0x8A)   # teal accent
LIGHT_BLU = RGBColor(0xD9, 0xEF, 0xF5)  # light blue (table alt rows)
WHITE     = RGBColor(0xFF, 0xFF, 0xFF)
DARK_TXT  = RGBColor(0x1C, 0x1C, 0x1C)
ORANGE    = RGBColor(0xE8, 0x7A, 0x1A)   # highlight / arrows
GREEN     = RGBColor(0x27, 0x8B, 0x44)
RED       = RGBColor(0xC0, 0x39, 0x2B)
YELLOW_BG = RGBColor(0xFF, 0xF3, 0xCD)
GRAY_BG   = RGBColor(0xF4, 0xF6, 0xF9)
HEADER_ROW= RGBColor(0x1A, 0x3A, 0x5C)

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

# ===== HELPER FUNCTIONS =====

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

def add_textbox(slide, x, y, w, h, text, font_size=16, bold=False, color=DARK_TXT,
                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_labeled_box(slide, x, y, w, h, text, bg_color, text_color=WHITE,
                    font_size=13, bold=True, align=PP_ALIGN.CENTER, border_color=None):
    shape = add_rect(slide, x, y, w, h, fill_color=bg_color,
                     line_color=border_color if border_color else bg_color)
    tf = shape.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    tf.margin_left = Pt(6)
    tf.margin_right = Pt(6)
    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.color.rgb = text_color
    run.font.name = "Calibri"
    return shape

def add_arrow_down(slide, cx, y_top, h=0.25, color=NAVY):
    """Draw a downward triangle arrow."""
    from pptx.util import Emu
    # Use a connector line
    line = slide.shapes.add_connector(1,
        Inches(cx), Inches(y_top),
        Inches(cx), Inches(y_top + h))
    line.line.color.rgb = color
    line.line.width = Pt(2)
    return line

def add_arrow_right(slide, x_start, y_mid, length=0.5, color=NAVY):
    line = slide.shapes.add_connector(1,
        Inches(x_start), Inches(y_mid),
        Inches(x_start + length), Inches(y_mid))
    line.line.color.rgb = color
    line.line.width = Pt(2)
    return line

def add_slide_header(slide, title, subtitle=None):
    """Add a colored header bar with title."""
    add_rect(slide, 0, 0, 13.333, 1.0, fill_color=NAVY)
    add_textbox(slide, 0.3, 0.1, 12.7, 0.75, title,
                font_size=28, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_textbox(slide, 0.3, 0.72, 12.7, 0.3, subtitle,
                    font_size=13, bold=False, color=RGBColor(0xAA, 0xCC, 0xDD),
                    align=PP_ALIGN.LEFT)
    # Bottom accent line
    add_rect(slide, 0, 1.0, 13.333, 0.06, fill_color=TEAL)

def add_footer(slide, page_num, total=8):
    add_rect(slide, 0, 7.2, 13.333, 0.3, fill_color=NAVY)
    add_textbox(slide, 0.3, 7.22, 9, 0.25,
                "Thyroid Investigations | MBBS Level",
                font_size=9, color=RGBColor(0xAA, 0xCC, 0xDD))
    add_textbox(slide, 11.5, 7.22, 1.7, 0.25,
                f"Slide {page_num} / {total}",
                font_size=9, color=RGBColor(0xAA, 0xCC, 0xDD), align=PP_ALIGN.RIGHT)

# =====================================================================
# SLIDE 1 – TITLE SLIDE
# =====================================================================
slide1 = prs.slides.add_slide(blank_layout)
# Full bg
add_rect(slide1, 0, 0, 13.333, 7.5, fill_color=NAVY)
# Accent strip
add_rect(slide1, 0, 3.5, 13.333, 0.08, fill_color=TEAL)
# Decorative side bar
add_rect(slide1, 0, 0, 0.4, 7.5, fill_color=TEAL)

add_textbox(slide1, 1.0, 1.4, 11, 1.0,
            "THYROID INVESTIGATIONS",
            font_size=44, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_textbox(slide1, 1.0, 2.5, 11, 0.6,
            "A Comprehensive Guide for MBBS Students",
            font_size=20, bold=False, color=RGBColor(0xAA, 0xDD, 0xEE),
            align=PP_ALIGN.CENTER)
add_textbox(slide1, 1.0, 3.7, 11, 0.5,
            "TSH  |  Free T4  |  Free T3  |  Antibodies  |  Imaging  |  Uptake Studies",
            font_size=14, bold=False, color=RGBColor(0x88, 0xBB, 0xCC),
            align=PP_ALIGN.CENTER)
add_textbox(slide1, 1.0, 5.5, 11, 0.4,
            "Includes: Tables  •  Diagnostic Flowcharts  •  Normal Reference Ranges",
            font_size=13, italic=True, color=RGBColor(0x77, 0xAA, 0xBB),
            align=PP_ALIGN.CENTER)
add_textbox(slide1, 1.0, 6.3, 11, 0.4,
            "Based on: Henry's Clinical Diagnosis  |  Quick Compendium of Clinical Pathology  |  Washington Manual",
            font_size=11, italic=True, color=RGBColor(0x66, 0x99, 0xAA),
            align=PP_ALIGN.CENTER)

# =====================================================================
# SLIDE 2 – OVERVIEW / HPT AXIS
# =====================================================================
slide2 = prs.slides.add_slide(blank_layout)
add_rect(slide2, 0, 0, 13.333, 7.5, fill_color=GRAY_BG)
add_slide_header(slide2, "Hypothalamus-Pituitary-Thyroid (HPT) Axis",
                 "Basis of all thyroid tests")
add_footer(slide2, 2)

# Axis boxes (left column)
axis_items = [
    ("HYPOTHALAMUS", "Releases TRH\n(Thyrotropin Releasing Hormone)", RGBColor(0x6A, 0x0D, 0xAD)),
    ("ANTERIOR PITUITARY", "Releases TSH\n(Thyroid Stimulating Hormone)", TEAL),
    ("THYROID GLAND", "Releases T3 & T4\n(Active hormones)", NAVY),
]
ay = 1.3
for title, desc, col in axis_items:
    add_labeled_box(slide2, 0.5, ay, 3.2, 0.7, title, col, font_size=12)
    add_textbox(slide2, 3.85, ay + 0.05, 4.0, 0.6, desc, font_size=12, color=DARK_TXT)
    if ay < 3.3:
        add_arrow_down(slide2, 2.1, ay + 0.7, 0.3, color=col)
    ay += 1.05

# Negative feedback arrow label
add_rect(slide2, 4.5, 1.3, 2.5, 2.5, fill_color=None, line_color=ORANGE, line_width=Pt(1.5))
add_textbox(slide2, 4.6, 1.4, 2.3, 0.35, "Negative Feedback", font_size=11, bold=True,
            color=ORANGE, align=PP_ALIGN.CENTER)
add_textbox(slide2, 4.6, 1.7, 2.3, 0.9,
            "High T3/T4 \u2192 inhibits TRH & TSH\nLow T3/T4 \u2192 stimulates TRH & TSH",
            font_size=11, color=ORANGE)

# Key concept box
add_labeled_box(slide2, 7.3, 1.3, 5.7, 2.0,
    "Key Concept for Thyroid Tests",
    NAVY, font_size=13)
add_textbox(slide2, 7.4, 1.7, 5.5, 1.5,
    "• TSH is the MOST SENSITIVE single test\n"
    "• TSH \u2191 = Primary Hypothyroidism\n"
    "• TSH \u2193 = Primary Hyperthyroidism\n"
    "• Free T4 confirms and quantifies\n"
    "• Free T3 used in special situations",
    font_size=13, color=DARK_TXT)

# T3/T4 metabolism info
add_labeled_box(slide2, 0.5, 3.8, 5.5, 0.45, "T4 Metabolism", TEAL, font_size=12)
add_textbox(slide2, 0.5, 4.25, 5.5, 1.6,
    "T4 (Thyroxine) – prohormone, 4 iodines\n"
    "T3 (Triiodothyronine) – active hormone, 3 iodines\n"
    "rT3 (Reverse T3) – inactive metabolite\n"
    "~99.98% of T4 and ~99.8% of T3 are protein-bound (TBG)\n"
    "ONLY FREE fractions are biologically active",
    font_size=12, color=DARK_TXT)

add_labeled_box(slide2, 7.3, 3.8, 5.7, 0.45, "TBG – Thyroid Binding Globulin", TEAL, font_size=12)
tbg_data = [
    ("TBG INCREASED by:", "Pregnancy, OCP/Estrogen, Active hepatitis, Hypothyroidism"),
    ("TBG DECREASED by:", "Hypoproteinemia, Androgens, Corticosteroids, Nephrotic syndrome"),
]
ty = 4.25
for label, val in tbg_data:
    add_textbox(slide2, 7.3, ty, 2.3, 0.55, label, font_size=11, bold=True, color=NAVY)
    add_textbox(slide2, 9.6, ty, 3.4, 0.55, val, font_size=11, color=DARK_TXT)
    ty += 0.6

# =====================================================================
# SLIDE 3 – TESTS OVERVIEW TABLE
# =====================================================================
slide3 = prs.slides.add_slide(blank_layout)
add_rect(slide3, 0, 0, 13.333, 7.5, fill_color=GRAY_BG)
add_slide_header(slide3, "Thyroid Function Tests – Overview Table",
                 "All major investigations at a glance")
add_footer(slide3, 3)

headers = ["Test", "What It Measures", "Normal Range", "Clinical Use", "Priority"]
col_widths = [2.0, 2.8, 2.2, 4.6, 1.3]
rows = [
    ["TSH\n(Thyrotropin)", "Pituitary TSH secretion\n(reflects thyroid status)", "0.4 – 4.0 mIU/L", "FIRST-LINE test; most sensitive\nscreening for all thyroid disorders", "1st"],
    ["Free T4\n(fT4)", "Unbound (active) T4\n(biologically relevant)", "0.8 – 1.8 ng/dL\n(10–23 pmol/L)", "Confirms hypothyroidism/hyperthyroidism;\ndosing thyroxine therapy", "2nd"],
    ["Free T3\n(fT3)", "Unbound (active) T3", "2.3 – 4.2 pg/mL\n(3.5–6.5 pmol/L)", "T3 toxicosis; severe hyperthyroid;\npituitary disease", "3rd"],
    ["Total T4", "Bound + free T4", "5 – 12 μg/dL\n(64–155 nmol/L)", "Affected by TBG changes;\nless preferred than fT4", "Supplementary"],
    ["Total T3", "Bound + free T3", "80 – 200 ng/dL\n(1.2–3.1 nmol/L)", "T3 toxicosis diagnosis", "Supplementary"],
    ["Anti-TPO Ab", "Thyroid peroxidase antibodies\n(autoimmune marker)", "< 34 IU/mL", "Hashimoto's thyroiditis;\nAITD diagnosis", "Autoimmune"],
    ["Anti-Tg Ab", "Thyroglobulin antibodies", "< 115 IU/mL", "Hashimoto's; PTC surveillance\n(interferes with Tg assay)", "Autoimmune"],
    ["TSI / TRAb", "TSH receptor antibodies\n(stimulating)", "< 1.75 IU/L", "Graves' disease diagnosis;\nneonatal thyrotoxicosis risk", "Autoimmune"],
    ["Thyroglobulin", "Thyroid tissue marker", "1.5 – 38 ng/mL", "Differentiated thyroid cancer\npost-thyroidectomy surveillance", "Tumour marker"],
    ["Calcitonin", "C-cell secretion marker", "< 10 pg/mL (F)\n< 18 pg/mL (M)", "Medullary thyroid carcinoma\nscreening / follow-up", "Tumour marker"],
]

# Draw table
start_x = 0.3
start_y = 1.15
row_h = 0.55
header_h = 0.45

# Header row
cx = start_x
for i, h in enumerate(headers):
    add_labeled_box(slide3, cx, start_y, col_widths[i], header_h, h,
                    HEADER_ROW, WHITE, font_size=11, bold=True)
    cx += col_widths[i]

row_colors = [LIGHT_BLU, WHITE]
for ri, row in enumerate(rows):
    cy = start_y + header_h + ri * row_h
    cx = start_x
    bg = row_colors[ri % 2]
    for ci, cell in enumerate(row):
        add_rect(slide3, cx, cy, col_widths[ci], row_h,
                 fill_color=bg, line_color=RGBColor(0xCC, 0xDD, 0xEE), line_width=Pt(0.5))
        fsize = 9 if ci == 3 else 10
        add_textbox(slide3, cx + 0.03, cy + 0.04, col_widths[ci] - 0.06, row_h - 0.08,
                    cell, font_size=fsize, color=DARK_TXT)
        cx += col_widths[ci]

# =====================================================================
# SLIDE 4 – TSH/T4/T3 PATTERN TABLE
# =====================================================================
slide4 = prs.slides.add_slide(blank_layout)
add_rect(slide4, 0, 0, 13.333, 7.5, fill_color=GRAY_BG)
add_slide_header(slide4, "TSH + fT4 + fT3 Pattern Recognition Table",
                 "Interpret thyroid function test combinations")
add_footer(slide4, 4)

# Main pattern table
p_headers = ["Condition", "TSH", "Free T4", "Free T3", "Site of Disease", "Notes"]
p_widths  = [2.8, 1.2, 1.2, 1.2, 2.4, 4.3]
p_rows = [
    ["Euthyroid (Normal)", "Normal\n(0.4–4.0)", "Normal", "Normal", "None", "All values within reference range"],
    ["Primary Hypothyroidism", "\u2191 HIGH", "\u2193 Low", "\u2193 Low/Normal", "Thyroid gland", "Most common: Hashimoto's, post-RAI, post-surgical"],
    ["Subclinical Hypothyroidism", "\u2191 HIGH", "Normal", "Normal", "Thyroid gland", "Early; TSH elevated, fT4 still normal; treat if TSH >10 or symptomatic"],
    ["Primary Hyperthyroidism", "\u2193 LOW\n(<0.1)", "\u2191 High", "\u2191 High", "Thyroid gland", "Graves', toxic MNG, toxic adenoma"],
    ["T3 Toxicosis", "\u2193 LOW", "Normal", "\u2191 High", "Thyroid gland", "Early Graves'; important – fT4 normal, only fT3 elevated"],
    ["Subclinical Hyperthyroidism", "\u2193 LOW", "Normal", "Normal", "Thyroid gland", "Suppressed TSH, normal fT4/fT3; risk: AF, osteoporosis"],
    ["Secondary Hypothyroidism", "\u2193 Low/Normal", "\u2193 Low", "\u2193 Low", "Pituitary", "Pituitary failure; TSH unhelpful; use fT4"],
    ["Secondary Hyperthyroidism", "\u2191 HIGH", "\u2191 High", "\u2191 High", "Pituitary (adenoma)", "Rare TSH-secreting pituitary adenoma"],
    ["Euthyroid Sick Syndrome", "Variable", "\u2193 Low", "\u2193 LOW", "Non-thyroidal illness", "Low T3 in any severe illness; adaptive response; do NOT treat"],
    ["Pregnancy / High TBG", "Normal", "\u2191 Total T4\n(fT4 normal)", "Normal", "Physiological", "Total T4 rises; free T4 normal; TSH may be low in 1st trimester"],
]

px = 0.3
py = 1.15
ph = 0.47
add_labeled_box(slide4, px, py, sum(p_widths), 0.4, None, HEADER_ROW)  # spacer
cx = px
for h, w in zip(p_headers, p_widths):
    add_labeled_box(slide4, cx, py, w, 0.4, h, HEADER_ROW, WHITE, font_size=11)
    cx += w

condition_colors = {
    "Euthyroid": GREEN,
    "Primary Hypothyroidism": NAVY,
    "Subclinical Hypothyroidism": TEAL,
    "Primary Hyperthyroidism": RED,
    "T3 Toxicosis": RED,
    "Subclinical Hyperthyroidism": ORANGE,
    "Secondary": RGBColor(0x6A, 0x0D, 0xAD),
    "Euthyroid Sick": ORANGE,
    "Pregnancy": RGBColor(0x2E, 0x86, 0xAB),
}

row_bgs = [LIGHT_BLU, WHITE]
for ri, row in enumerate(p_rows):
    cy = py + 0.4 + ri * ph
    cx = px
    bg = row_bgs[ri % 2]
    for ci, (cell, w) in enumerate(zip(row, p_widths)):
        clr = bg
        txt_clr = DARK_TXT
        if ci == 0:
            clr = bg
        elif ci in (1, 2, 3):  # TSH, fT4, fT3 cells
            if "\u2191" in cell:
                clr = RGBColor(0xFF, 0xE5, 0xE5)
                txt_clr = RED
            elif "\u2193" in cell:
                clr = RGBColor(0xE5, 0xF0, 0xFF)
                txt_clr = NAVY
            else:
                clr = RGBColor(0xE8, 0xF8, 0xE8)
                txt_clr = GREEN
        add_rect(slide4, cx, cy, w, ph, fill_color=clr,
                 line_color=RGBColor(0xCC, 0xDD, 0xEE), line_width=Pt(0.5))
        fsize = 9 if ci == 5 else 10
        bold = (ci == 0)
        add_textbox(slide4, cx + 0.03, cy + 0.03, w - 0.06, ph - 0.06,
                    cell, font_size=fsize, bold=bold, color=txt_clr)
        cx += w

# Color legend
add_textbox(slide4, 0.3, 6.85, 12, 0.3,
    "\u2191 = Elevated (red)     \u2193 = Decreased (blue)     Normal = Green     Note: fT4 = free T4 is preferred over total T4",
    font_size=10, color=DARK_TXT, italic=True)

# =====================================================================
# SLIDE 5 – DIAGNOSTIC FLOWCHART: Approach to Thyroid Disease
# =====================================================================
slide5 = prs.slides.add_slide(blank_layout)
add_rect(slide5, 0, 0, 13.333, 7.5, fill_color=GRAY_BG)
add_slide_header(slide5, "Diagnostic Flowchart: Step-by-Step Approach",
                 "Start with TSH → then fT4 → then specific tests")
add_footer(slide5, 5)

# ---- FLOWCHART ----
BOX_W = 2.4
BOX_H = 0.55

# Step 1: Clinical Suspicion
add_labeled_box(slide5, 5.0, 1.15, 3.333, 0.55,
    "CLINICAL SUSPICION OF THYROID DISEASE", ORANGE, WHITE, font_size=11)
add_arrow_down(slide5, 6.666, 1.7, 0.2, ORANGE)

# Step 2: TSH
add_labeled_box(slide5, 4.7, 1.9, 3.9, 0.6,
    "STEP 1: Measure Serum TSH\n(Most sensitive screening test)", NAVY, WHITE, font_size=11)
add_arrow_down(slide5, 6.666, 2.5, 0.2, NAVY)

# Branch: Low / Normal / High
add_labeled_box(slide5, 0.4, 2.7, 2.8, 0.55, "TSH LOW\n(< 0.4 mIU/L)", RED, WHITE, font_size=11)
add_labeled_box(slide5, 5.2, 2.7, 2.9, 0.55, "TSH NORMAL\n(0.4 – 4.0 mIU/L)", GREEN, WHITE, font_size=11)
add_labeled_box(slide5, 10.0, 2.7, 2.9, 0.55, "TSH HIGH\n(> 4.0 mIU/L)", NAVY, WHITE, font_size=11)

# Arrows from TSH to branches
add_arrow_right(slide5, 4.7, 3.0, -1.5)   # left
# right arrow
line = slide5.shapes.add_connector(1, Inches(8.1), Inches(3.0), Inches(10.0), Inches(3.0))
line.line.color.rgb = NAVY
line.line.width = Pt(2)

# Normal branch -> Euthyroid / recheck
add_arrow_down(slide5, 6.65, 3.25, 0.2, GREEN)
add_labeled_box(slide5, 5.0, 3.45, 3.3, 0.65,
    "EUTHYROID\nNo thyroid disease\n(monitor if symptoms persist)", GREEN, WHITE, font_size=10)

# LOW TSH branch
add_arrow_down(slide5, 1.8, 3.25, 0.25, RED)
add_labeled_box(slide5, 0.3, 3.5, 3.0, 0.55, "STEP 2: Measure Free T4 + Free T3", TEAL, WHITE, font_size=11)
add_arrow_down(slide5, 1.8, 4.05, 0.2, TEAL)
add_labeled_box(slide5, 0.2, 4.25, 1.5, 0.55, "fT4 \u2191 & fT3 \u2191", RED, WHITE, font_size=11)
add_textbox(slide5, 0.2, 4.85, 1.5, 0.5, "Overt\nHyperthyroidism", font_size=10, color=RED, bold=True)
add_labeled_box(slide5, 1.8, 4.25, 1.6, 0.55, "fT4 Normal\nfT3 \u2191", ORANGE, WHITE, font_size=10)
add_textbox(slide5, 1.82, 4.85, 1.55, 0.5, "T3 Toxicosis\n(early Graves')", font_size=10, color=ORANGE, bold=True)

add_arrow_down(slide5, 1.8, 5.4, 0.25, TEAL)
add_labeled_box(slide5, 0.2, 5.65, 3.1, 0.55,
    "STEP 3: TRAb / TSI  +  Thyroid Scan + RAIU", TEAL, WHITE, font_size=10)
add_textbox(slide5, 0.3, 6.25, 3.0, 0.65,
    "Graves' (+ TRAb, diffuse uptake)\nToxic MNG (patchy uptake)\nToxic Adenoma (hot nodule)",
    font_size=9, color=DARK_TXT)

# HIGH TSH branch
add_arrow_down(slide5, 11.45, 3.25, 0.25, NAVY)
add_labeled_box(slide5, 9.9, 3.5, 3.0, 0.55, "STEP 2: Measure Free T4", TEAL, WHITE, font_size=11)
add_arrow_down(slide5, 11.45, 4.05, 0.2, TEAL)
add_labeled_box(slide5, 9.8, 4.25, 1.55, 0.55, "fT4 \u2193 Low", NAVY, WHITE, font_size=11)
add_textbox(slide5, 9.82, 4.85, 1.5, 0.5, "Primary\nHypothyroidism", font_size=10, color=NAVY, bold=True)
add_labeled_box(slide5, 11.45, 4.25, 1.55, 0.55, "fT4 Normal", GREEN, WHITE, font_size=11)
add_textbox(slide5, 11.47, 4.85, 1.5, 0.5, "Subclinical\nHypothyroidism", font_size=10, color=GREEN, bold=True)

add_arrow_down(slide5, 11.45, 5.4, 0.25, NAVY)
add_labeled_box(slide5, 9.9, 5.65, 3.1, 0.55,
    "STEP 3: Anti-TPO Ab + Anti-Tg Ab", TEAL, WHITE, font_size=10)
add_textbox(slide5, 10.0, 6.25, 3.0, 0.65,
    "Anti-TPO + \u2192 Hashimoto's thyroiditis\nCheck TSH yearly if subclinical\nThyroxine if TSH > 10 or symptomatic",
    font_size=9, color=DARK_TXT)

# =====================================================================
# SLIDE 6 – ANTIBODY / AUTOIMMUNE TABLE
# =====================================================================
slide6 = prs.slides.add_slide(blank_layout)
add_rect(slide6, 0, 0, 13.333, 7.5, fill_color=GRAY_BG)
add_slide_header(slide6, "Thyroid Antibodies & Autoimmune Tests",
                 "Key serological markers for autoimmune thyroid disease")
add_footer(slide6, 6)

ab_headers = ["Antibody", "Full Name", "Target", "Normal", "Positive in", "Key Clinical Use"]
ab_widths = [1.8, 2.8, 2.2, 1.5, 2.5, 2.3]
ab_rows = [
    ["Anti-TPO\n(TPOAb)", "Anti-thyroid peroxidase antibody", "Thyroid peroxidase enzyme", "< 34 IU/mL",
     "Hashimoto's (>90%)\nGraves' (60-80%)", "Best single autoimmune marker;\npredicts hypothyroidism risk"],
    ["Anti-Tg\n(TgAb)", "Anti-thyroglobulin antibody", "Thyroglobulin protein", "< 115 IU/mL",
     "Hashimoto's (80%)\nGraves' (50-70%)", "Interferes with Tg tumour marker;\nmeasure alongside Tg"],
    ["TRAb\n(TSHRAb)", "TSH receptor antibody\n(blocking or stimulating)", "TSH receptor on thyroid cells", "< 1.75 IU/L",
     "Graves' disease (95%+)\nNeonatal thyrotoxicosis", "Confirms Graves';\nmonitor during anti-thyroid therapy"],
    ["TSI", "Thyroid stimulating immunoglobulin", "TSH receptor\n(stimulating type only)", "< 140%\n(% of baseline)",
     "Graves' disease (specific)", "More specific than TRAb;\npredicts neonatal disease"],
    ["Thyroglobulin\n(Tg)", "Tumour marker (not antibody)", "Thyroid follicular cells", "1.5–38 ng/mL\n(varies by lab)",
     "After total thyroidectomy\nfor DTC (should be undetectable)", "Surveillance for papillary/\nfollicular thyroid cancer recurrence"],
    ["Calcitonin", "C-cell hormone (not antibody)", "Parafollicular C-cells", "< 10 pg/mL (F)\n< 18 pg/mL (M)",
     "Medullary thyroid carcinoma\n(MTC); MEN2", "Screening in thyroid nodules;\nMTC diagnosis & follow-up"],
]

ax2 = 0.3; ay2 = 1.15; ah = 0.77
cx = ax2
for h, w in zip(ab_headers, ab_widths):
    add_labeled_box(slide6, cx, ay2, w, 0.4, h, HEADER_ROW, WHITE, font_size=11)
    cx += w

for ri, row in enumerate(ab_rows):
    cy = ay2 + 0.4 + ri * ah
    cx = ax2
    bg = [LIGHT_BLU, WHITE][ri % 2]
    for ci, (cell, w) in enumerate(zip(row, ab_widths)):
        add_rect(slide6, cx, cy, w, ah, fill_color=bg,
                 line_color=RGBColor(0xCC, 0xDD, 0xEE), line_width=Pt(0.5))
        fs = 9 if ci in (5, 4) else 10
        bold = (ci == 0)
        add_textbox(slide6, cx + 0.04, cy + 0.04, w - 0.08, ah - 0.08,
                    cell, font_size=fs, bold=bold, color=DARK_TXT)
        cx += w

# =====================================================================
# SLIDE 7 – IMAGING & SPECIAL INVESTIGATIONS TABLE
# =====================================================================
slide7 = prs.slides.add_slide(blank_layout)
add_rect(slide7, 0, 0, 13.333, 7.5, fill_color=GRAY_BG)
add_slide_header(slide7, "Imaging & Special Thyroid Investigations",
                 "Ultrasound, RAIU, Scan, FNAC, and more")
add_footer(slide7, 7)

im_headers = ["Investigation", "Principle", "What It Shows", "Main Indications", "Notes / Limitations"]
im_widths  = [2.2, 2.2, 2.8, 3.0, 2.8]
im_rows = [
    ["Thyroid Ultrasound\n(USG)", "High-frequency sound waves",
     "Size, nodules, echotexture,\nvascularization (Doppler)",
     "Nodule characterization\nGoitre evaluation\nGuide FNAC",
     "First-line imaging; no radiation;\nTIRADS scoring for malignancy risk"],
    ["Radioactive Iodine Uptake\n(RAIU / RAIU-24h)", "131I or 123I uptake\nmeasured at 2h & 24h",
     "Thyroid iodine uptake\n(% of administered dose)",
     "Hyperthyroidism workup\nGraves' vs. thyroiditis\nvs. toxic nodule",
     "Normal: 5-25% at 24h\nHigh in Graves', toxic nodule\nLow in thyroiditis, exogenous T4"],
    ["Thyroid Scintigraphy\n(Tc-99m or I-123 Scan)", "Gamma camera imaging\nafter isotope injection",
     "Nodule function:\nHot (hyperfunctioning)\nWarm / Cold nodule",
     "Solitary thyroid nodule\nEctopic thyroid\nPost-thyroidectomy remnant",
     "Cold nodule: 15-20% malignant risk;\nrequires FNAC\nHot nodule: rarely malignant"],
    ["FNAC / FNA Biopsy\n(Thyroid)", "Fine needle aspiration\ncytology",
     "Cell morphology;\nBethesda classification\n(I–VI)",
     "All clinically/USG suspicious\nnodules > 1 cm",
     "Bethesda III-VI warrants\nsurgical referral;\ngold standard for nodule Dx"],
    ["CT / MRI Thyroid", "X-ray (CT) or\nMRI imaging",
     "Extent, retrosternal\ngoitre, tracheal compression,\nLN involvement",
     "Large/substernal goitre\nSurgical planning\nMalignancy staging",
     "CT: risk of iodinated contrast\ndelaying RAI therapy\nMRI preferred pre-RAI"],
    ["PET Scan\n(FDG-PET/CT)", "Fluorodeoxyglucose\nuptake",
     "Metabolically active\nmetastases",
     "Radioiodine-negative\nrecurrent/metastatic DTC",
     "Used when RAI scan negative\nbut Tg rising;\nnot routine"],
]

ix = 0.3; iy = 1.15; irh = 0.88
cx = ix
for h, w in zip(im_headers, im_widths):
    add_labeled_box(slide7, cx, iy, w, 0.4, h, HEADER_ROW, WHITE, font_size=11)
    cx += w

for ri, row in enumerate(im_rows):
    cy = iy + 0.4 + ri * irh
    cx = ix
    bg = [LIGHT_BLU, WHITE][ri % 2]
    for ci, (cell, w) in enumerate(zip(row, im_widths)):
        add_rect(slide7, cx, cy, w, irh, fill_color=bg,
                 line_color=RGBColor(0xCC, 0xDD, 0xEE), line_width=Pt(0.5))
        fs = 9 if ci in (2, 3, 4) else 10
        bold = (ci == 0)
        add_textbox(slide7, cx + 0.04, cy + 0.04, w - 0.08, irh - 0.08,
                    cell, font_size=fs, bold=bold, color=DARK_TXT)
        cx += w

# =====================================================================
# SLIDE 8 – SUMMARY / QUICK REFERENCE
# =====================================================================
slide8 = prs.slides.add_slide(blank_layout)
add_rect(slide8, 0, 0, 13.333, 7.5, fill_color=GRAY_BG)
add_slide_header(slide8, "Quick Summary & Clinical Pearls",
                 "Remember these for MBBS exams and clinical practice")
add_footer(slide8, 8)

# Left column: Quick Reference Flowchart
add_labeled_box(slide8, 0.3, 1.15, 6.0, 0.4, "QUICK DIAGNOSTIC SUMMARY", NAVY, WHITE, font_size=13)

quick_items = [
    (ORANGE, "1. TSH ALONE is sufficient for initial screening."),
    (NAVY,   "2. TSH \u2191 + fT4 \u2193 = Primary Hypothyroidism (treat with Levothyroxine)"),
    (NAVY,   "3. TSH \u2191 + fT4 Normal = Subclinical Hypothyroidism (monitor TSH 6-monthly)"),
    (RED,    "4. TSH \u2193 + fT4 \u2191 + fT3 \u2191 = Overt Hyperthyroidism (carbimazole/RAI/surgery)"),
    (RED,    "5. TSH \u2193 + fT4 Normal + fT3 \u2191 = T3 Toxicosis (Graves' - early)"),
    (RED,    "6. TSH \u2193 + fT4 Normal + fT3 Normal = Subclinical Hyperthyroidism"),
    (RGBColor(0x6A, 0x0D, 0xAD), "7. TSH \u2193 + fT4 \u2193 = Secondary Hypothyroidism (pituitary disease)"),
    (TEAL,   "8. Anti-TPO Ab+ = Hashimoto's   |   TRAb+ = Graves' disease"),
    (ORANGE, "9. Cold nodule on scan + suspicious FNAC = Refer surgery"),
    (GREEN,  "10. Post-thyroidectomy: monitor Thyroglobulin for cancer recurrence"),
]
qy = 1.6
for col, txt in quick_items:
    add_labeled_box(slide8, 0.3, qy, 0.3, 0.36, "\u25cf", col, WHITE, font_size=14)
    add_textbox(slide8, 0.7, qy + 0.02, 5.5, 0.36, txt, font_size=11, color=DARK_TXT)
    qy += 0.41

# Right column: Drugs affecting TFT
add_labeled_box(slide8, 6.8, 1.15, 6.2, 0.4, "DRUGS AFFECTING THYROID FUNCTION TESTS", TEAL, WHITE, font_size=12)
drug_rows = [
    ["Drug / Substance", "Effect on Tests"],
    ["Amiodarone, Radiocontrast", "Can cause hypo- OR hyperthyroidism (iodine overload)"],
    ["Lithium", "Blocks thyroid hormone release \u2192 Hypothyroidism"],
    ["Glucocorticoids, Dopamine", "Suppress TSH secretion \u2192 Falsely low TSH"],
    ["Estrogen / OCP / Pregnancy", "Increase TBG \u2192 Raise total T4 (free T4 normal)"],
    ["Androgens, Nephrotic syn.", "Decrease TBG \u2192 Lower total T4 (free T4 normal)"],
    ["Phenytoin, Carbamazepine", "Increase T4 metabolism \u2192 Lower total T4"],
    ["Furosemide (high dose)", "Displaces T4 from TBG \u2192 Lower total T4"],
    ["Aspirin / Salicylates", "Displaces T4 from TBG \u2192 Lower total T4"],
]
dy = 1.6
for ri, (drug, effect) in enumerate(drug_rows):
    bg = HEADER_ROW if ri == 0 else [LIGHT_BLU, WHITE][ri % 2]
    tc = WHITE if ri == 0 else DARK_TXT
    bold = (ri == 0)
    add_rect(slide8, 6.8, dy, 2.8, 0.38, fill_color=bg,
             line_color=RGBColor(0xCC, 0xDD, 0xEE), line_width=Pt(0.5))
    add_textbox(slide8, 6.85, dy + 0.03, 2.7, 0.32, drug, font_size=10, bold=bold, color=tc)
    add_rect(slide8, 9.6, dy, 3.4, 0.38, fill_color=bg,
             line_color=RGBColor(0xCC, 0xDD, 0xEE), line_width=Pt(0.5))
    add_textbox(slide8, 9.65, dy + 0.03, 3.3, 0.32, effect, font_size=10, bold=bold, color=tc)
    dy += 0.38

# Memory tip box
add_labeled_box(slide8, 6.8, 5.2, 6.2, 0.4, "MEMORY TIPS", ORANGE, WHITE, font_size=12)
tips = [
    "\"TSH is the BOSS\" - always start with TSH",
    "\"Free is Better\" - free T4 > total T4 (not affected by TBG changes)",
    "\"High TSH = Hypo, Low TSH = Hyper\" (for PRIMARY disease)",
    "\"Cold nodule = Worried\" - needs FNAC to rule out malignancy",
    "\"TRAb = Graves' proof\" - highly specific",
]
ty2 = 5.65
for tip in tips:
    add_textbox(slide8, 7.0, ty2, 5.9, 0.36, f"\u2022 {tip}", font_size=10, color=DARK_TXT)
    ty2 += 0.3

# Save
out_path = "/tmp/workspace/thyroid-pptx/Thyroid_Investigations_MBBS.pptx"
buf = BytesIO()
prs.save(buf)
with open(out_path, "wb") as f:
    f.write(buf.getvalue())
print(f"Saved: {out_path}")

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/thyroid-pptx/create_pptx.py'