https://orris.care/shared/chat/d6482651-fa6b-4ea5-84e6-05d2c…

ls -la /tmp/workspace/ 2>/dev/null || echo "workspace empty or missing"

mkdir -p /tmp/workspace/thyroid-paeds && python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.platypus import (SimpleDocTemplate, Table, TableStyle, Paragraph, Spacer, HRFlowable) from reportlab.lib.styles import ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from reportlab.platypus import KeepTogether OUTPUT = "/tmp/workspace/thyroid-paeds/Hyperthyroidism_vs_CongenitalHypothyroidism_Paeds.pdf" # ── COLOUR PALETTE ────────────────────────────────────────────────────────── HYPER_DARK = colors.HexColor("#C62828") # deep red – hyperthyroidism HYPER_MID = colors.HexColor("#EF5350") # mid red HYPER_LIGHT = colors.HexColor("#FFEBEE") # pale red HYPO_DARK = colors.HexColor("#1565C0") # deep blue – hypothyroidism HYPO_MID = colors.HexColor("#42A5F5") # mid blue HYPO_LIGHT = colors.HexColor("#E3F2FD") # pale blue BANNER_BG = colors.HexColor("#212121") # near-black banner DARK_GREY = colors.HexColor("#333333") MID_GREY = colors.HexColor("#555555") GOLD = colors.HexColor("#F9A825") LIGHT_YELLOW = colors.HexColor("#FFFDE7") WHITE = colors.white ROW_ALT = colors.HexColor("#FAFAFA") HEADER_ROW = colors.HexColor("#ECEFF1") # ── DOCUMENT ──────────────────────────────────────────────────────────────── doc = SimpleDocTemplate( OUTPUT, pagesize=A4, leftMargin=1.5*cm, rightMargin=1.5*cm, topMargin=1.2*cm, bottomMargin=1.2*cm, ) W = A4[0] - 3*cm # usable width # ── STYLES ────────────────────────────────────────────────────────────────── def sty(name, **kw): return ParagraphStyle(name, **kw) banner_title = sty("BT", fontSize=15, fontName="Helvetica-Bold", textColor=WHITE, leading=20, alignment=TA_CENTER) banner_sub = sty("BS", fontSize=9, fontName="Helvetica", textColor=colors.HexColor("#BDBDBD"), leading=13, alignment=TA_CENTER) section_hdr = sty("SH", fontSize=9, fontName="Helvetica-Bold", textColor=WHITE, leading=12, alignment=TA_CENTER) bold_s = sty("BoldS", fontSize=9, fontName="Helvetica-Bold", textColor=DARK_GREY, leading=13) norm_s = sty("NormS", fontSize=8.5, fontName="Helvetica", textColor=DARK_GREY, leading=13, alignment=TA_LEFT) num_s = sty("NumS", fontSize=10, fontName="Helvetica-Bold", textColor=WHITE, leading=14, alignment=TA_CENTER) cat_s = sty("CatS", fontSize=7.5, fontName="Helvetica-Bold", textColor=MID_GREY, leading=11, alignment=TA_CENTER) hyper_hdr = sty("HH", fontSize=8.5, fontName="Helvetica-Bold", textColor=WHITE, leading=12, alignment=TA_CENTER) hypo_hdr = sty("HypoH", fontSize=8.5, fontName="Helvetica-Bold", textColor=WHITE, leading=12, alignment=TA_CENTER) cell_s = sty("Cell", fontSize=8, fontName="Helvetica", textColor=DARK_GREY, leading=12, alignment=TA_LEFT) bold_cell = sty("BCell", fontSize=8, fontName="Helvetica-Bold", textColor=DARK_GREY, leading=12, alignment=TA_LEFT) note_s = sty("Note", fontSize=8, fontName="Helvetica-Oblique", textColor=MID_GREY, leading=12, alignment=TA_CENTER) gold_rule = sty("GoldRule", fontSize=9, fontName="Helvetica-Bold", textColor=DARK_GREY, leading=14, alignment=TA_CENTER) # ── HELPERS ───────────────────────────────────────────────────────────────── def p(text, style=cell_s): return Paragraph(text, style) def bp(text): return Paragraph(text, bold_cell) story = [] # ════════════════════════════════════════════════════════════════ # TITLE BANNER # ════════════════════════════════════════════════════════════════ title_data = [ [Paragraph("HYPERTHYROIDISM vs CONGENITAL HYPOTHYROIDISM", banner_title)], [Paragraph("Paediatric Differentiation • 20 Must-Know Points • Exam Ready", banner_sub)], ] title_tbl = Table(title_data, colWidths=[W]) title_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), BANNER_BG), ("TOPPADDING", (0,0), (-1,-1), 10), ("BOTTOMPADDING",(0,0),(-1,-1), 10), ("LEFTPADDING", (0,0), (-1,-1), 12), ("RIGHTPADDING",(0,0), (-1,-1), 12), ("ROUNDEDCORNERS", (0,0),(-1,-1), [8,8,0,0]), ])) story.append(title_tbl) story.append(Spacer(1, 6)) # ════════════════════════════════════════════════════════════════ # QUICK DEFINITIONS BOX # ════════════════════════════════════════════════════════════════ def_style = sty("DefS", fontSize=8.5, fontName="Helvetica", textColor=DARK_GREY, leading=14, alignment=TA_LEFT) def_data = [ [Paragraph("QUICK DEFINITIONS", bold_s)], [Paragraph( "<b>Hyperthyroidism (Graves' Disease):</b> An <b>autoimmune</b> condition where TSH-receptor " "antibodies (<b>TRAb / TSI</b>) stimulate the thyroid to produce excess T3 & T4. " "Result: hypermetabolic state — everything speeds up.", def_style)], [Paragraph( "<b>Congenital Hypothyroidism (CH):</b> Thyroid hormone deficiency present <b>from birth</b>, " "most commonly due to thyroid gland aplasia / hypoplasia / ectopia. " "Result: slowed metabolism — if missed, causes irreversible <b>intellectual disability (cretinism)</b>.", def_style)], [Paragraph( "<b>WHY CONFUSE THEM?</b> Both are thyroid disorders in children. " "Graves' typically presents in <b>older children / adolescents</b>; " "CH is a <b>neonatal / infant</b> emergency — early detection via newborn screening is life-saving.", def_style)], ] def_tbl = Table(def_data, colWidths=[W]) def_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (0,0), HEADER_ROW), ("BACKGROUND", (0,1), (-1,-1), LIGHT_YELLOW), ("BOX", (0,0), (-1,-1), 1.2, GOLD), ("LINEBELOW", (0,0), (0,0), 0.8, GOLD), ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING",(0,0),(-1,-1), 6), ("LEFTPADDING", (0,0), (-1,-1), 10), ("RIGHTPADDING",(0,0), (-1,-1), 10), ])) story.append(def_tbl) story.append(Spacer(1, 8)) # ════════════════════════════════════════════════════════════════ # COLUMN-HEADER ROW # ════════════════════════════════════════════════════════════════ COL_W = [W*0.05, W*0.10, W*0.42, W*0.43] # #, category, hyper, hypo hdr_data = [[ p("#", section_hdr), p("CAT", section_hdr), p("🔴 HYPERTHYROIDISM (Graves' Disease)", hyper_hdr), p("🔵 CONGENITAL HYPOTHYROIDISM", hypo_hdr), ]] hdr_tbl = Table(hdr_data, colWidths=COL_W) hdr_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0),(0,0), colors.HexColor("#424242")), ("BACKGROUND", (1,0),(1,0), colors.HexColor("#424242")), ("BACKGROUND", (2,0),(2,0), HYPER_DARK), ("BACKGROUND", (3,0),(3,0), HYPO_DARK), ("TOPPADDING", (0,0),(-1,-1), 7), ("BOTTOMPADDING",(0,0),(-1,-1), 7), ("LEFTPADDING", (0,0),(-1,-1), 6), ("RIGHTPADDING",(0,0),(-1,-1), 6), ("VALIGN", (0,0),(-1,-1), "MIDDLE"), ])) story.append(hdr_tbl) # ════════════════════════════════════════════════════════════════ # DATA ROWS — (num, emoji_cat, cat_label, bg_colour, feature, hyper_text, hypo_text) # ════════════════════════════════════════════════════════════════ CAT_A = "🧬\nAETIOLOGY" CAT_B = "👶\nPATIENT" CAT_C = "🩺\nCLINICAL" CAT_D = "🔬\nINVESTIGATION" CAT_E = "💊\nTREATMENT" CAT_F = "⚠️\nCOMPLICATION" rows = [ # (num, cat_label, bg, feature, hyper_text, hypo_text) ("1", CAT_A, colors.HexColor("#FCE4EC"), "Aetiology /\nCause", "AUTOIMMUNE\nTSH-receptor antibodies (TRAb/TSI)\nstimulate thyroid to overproduce T3 & T4\n(Graves' disease = #1 cause in children)", "STRUCTURAL / DEVELOPMENTAL\n90%: Thyroid aplasia, hypoplasia or ectopia\n10%: Dyshormonogenesis (enzyme defects)\nRare: Maternal antithyroid drugs crossing placenta"), ("2", CAT_B, colors.HexColor("#E3F2FD"), "Age of\nPresentation", "OLDER CHILD / ADOLESCENT\nTypically 10–15 years\nRare before 5 years\nFemale > Male (5:1)", "NEONATE / INFANT\nPresent from birth (detected day 2–5)\nEarliest endocrine emergency in newborns\nF = M (equal sex ratio)"), ("3", CAT_A, colors.HexColor("#FCE4EC"), "Thyroid Gland\nSize", "GOITRE — ALWAYS PRESENT\nDiffuse, soft, non-tender goitre\nBruit may be heard over thyroid\n(high vascularity)", "SMALL / ABSENT GLAND\nNo goitre (aplasia/ectopia)\nOccasional goitre if dyshormonogenesis\nor if maternal antithyroid drugs used"), ("4", CAT_C, colors.HexColor("#FFF8E1"), "General\nAppearance", "HYPERACTIVE, ANXIOUS CHILD\nRestless, irritable, cannot sit still\nEmotional lability, mood swings\nAppears 'wired' and overactive", "LETHARGIC, PLACID BABY\nHypotonia — floppy infant\nExcessive sleeping, poor cry\nFeeds poorly, appears 'too good'"), ("5", CAT_C, colors.HexColor("#FFF8E1"), "Weight /\nGrowth", "WEIGHT LOSS despite increased appetite\nAccelerated linear growth\nAdvanced bone age\n(premature closure of epiphyses risk)", "WEIGHT GAIN / POOR GROWTH\nGrowth retardation — short stature\nDelayed bone age\nDelayed closure of fontanelles"), ("6", CAT_C, colors.HexColor("#FFF8E1"), "Cardiovascular\nFindings", "TACHYCARDIA — persistent\nHigh output state\nWide pulse pressure\nPalpitations, atrial fibrillation (rare in kids)\nHypertension (systolic)", "BRADYCARDIA\nLow output state\nMuffled heart sounds\nProlonged jaundice in neonates (poor cardiac output)\nHypotension"), ("7", CAT_C, colors.HexColor("#FFF8E1"), "Skin &\nTemperature", "WARM, MOIST SKIN\nHeat intolerance, excessive sweating\nFlushed appearance\nSoft, fine hair\nOnycholysis (nail separation)", "COOL, DRY, MOTTLED SKIN\nCold intolerance\nPallor / slight jaundice (prolonged)\nCoarse, dry hair\nUmbilical hernia"), ("8", CAT_C, colors.HexColor("#FFF8E1"), "Neurological\n/ Behaviour", "HYPERREFLEXIA\nTremor (fine hand tremor)\nShort attention span / school difficulties\nAnxiety, sleep disturbance\nEmotion dysregulation", "HYPOREFLEXIA\nHypotonia (floppy)\nDevelopmental delay if untreated\nMental retardation (cretinism) if missed\nSensorineural deafness (severe cases)"), ("9", CAT_C, colors.HexColor("#FFF8E1"), "Eyes", "EXOPHTHALMOS / PROPTOSIS\nLid lag, lid retraction (stellwag sign)\nStaring gaze\n(Graves' ophthalmopathy)\nInfrequent blinking", "NO EYE SIGNS\nNo proptosis\nPuffy eyelids possible (myxoedema)\nSunken fontanelle absent\nLarge tongue may be noted"), ("10", CAT_C, colors.HexColor("#FFF8E1"), "GI /\nBowel", "DIARRHOEA / FREQUENT STOOLS\nIncreased gut motility\nNausea, vomiting\nHyperphagia (eats a lot, still loses weight)", "CONSTIPATION\nDecreased gut motility\nAbdominal distension\nPoor feeding / difficulty suckling\n(classic neonatal triad)"), ("11", CAT_D, colors.HexColor("#E8F5E9"), "TSH Level", "SUPPRESSED (↓↓ TSH)\n< 0.1 mIU/L\nNegative feedback from excess T3/T4\nKEY: Low TSH = Hyperthyroid", "ELEVATED (↑↑ TSH)\n> 20 mIU/L (primary CH)\nPituitary responds to low T4 by pumping TSH\nKEY: High TSH = Hypothyroid"), ("12", CAT_D, colors.HexColor("#E8F5E9"), "Free T4 &\nFree T3", "ELEVATED (↑↑ Free T4 & T3)\nBoth T3 and T4 elevated\nT3 toxicosis possible (T3 high, T4 normal)\nRatio T3:T4 often elevated", "LOW (↓↓ Free T4)\nT4 deficient\nIn compensated CH: T4 low-normal, TSH raised\nT3 may be preserved longer (less sensitive)"), ("13", CAT_D, colors.HexColor("#E8F5E9"), "Antibodies", "TRAb / TSI POSITIVE\n(TSH-receptor stimulating antibodies)\nAnti-TPO may also be positive\nDefines autoimmune aetiology", "ANTIBODIES USUALLY ABSENT\n(unless maternal Hashimoto's)\nMaternal TSH-blocking antibodies\nmay cause transient CH in neonate"), ("14", CAT_D, colors.HexColor("#E8F5E9"), "Thyroid\nImaging", "DIFFUSE UPTAKE on radionuclide scan\nThyroid enlarged, homogeneous\nIncreased vascularity on Doppler\nNo nodules", "ABSENT / ECTOPIC GLAND on scan\nNo uptake in normal position (aplasia)\nEctopic uptake at base of tongue\nUltrasonography confirms anatomy"), ("15", CAT_D, colors.HexColor("#E8F5E9"), "Newborn\nScreening", "NOT DETECTED ON NBS\n(Graves' presents later in childhood)\nDiagnosed clinically + TFTs", "DETECTED ON NEWBORN SCREEN\nHeel prick day 2–5: High TSH (or low T4)\nConfirmed by serum TSH + free T4\nMUST treat within first 2 weeks of life"), ("16", CAT_D, colors.HexColor("#E8F5E9"), "Bone Age &\nGrowth Plate", "ADVANCED BONE AGE\nEpiphyses may fuse prematurely\nFinal height may be compromised\nif untreated long-term", "DELAYED BONE AGE\nDelayed epiphyseal ossification\nWormian bones on skull X-ray\nDelayed dentition"), ("17", CAT_E, colors.HexColor("#EDE7F6"), "First-Line\nTreatment", "ANTITHYROID DRUGS (ATDs)\nMethimazole (carbimazole) — 1st choice\nPropylthiouracil (PTU) — 2nd line\n+ Beta-blockers (propranolol) for symptoms", "LEVOTHYROXINE (T4 replacement)\nStart IMMEDIATELY (within 2 weeks of birth)\nDose: 10–15 mcg/kg/day (neonate)\nGoal: Normalise T4 in 2 weeks, TSH in 1 month"), ("18", CAT_E, colors.HexColor("#EDE7F6"), "Definitive /\nSurgical Option", "TOTAL THYROIDECTOMY\n(ATA recommends if surgery chosen)\nHigh-volume paediatric surgeon essential\nRAI (radioactive iodine): used > 10 yrs,\nnot preferred in young children", "LIFELONG T4 REPLACEMENT\nNo surgery needed\nMonitor TFTs every 3–6 months\nDose adjusted as child grows"), ("19", CAT_F, colors.HexColor("#FBE9E7"), "Major\nComplication\nif Untreated", "THYROID STORM (rare but life-threatening)\nCardiac failure, arrhythmia\nTall stature / premature epiphyseal fusion\nOphthalmic complications (corneal exposure)", "CRETINISM (permanent)\nSevere intellectual disability\nDeafness, spastic diplegia\nGrowth failure / dwarfism\nIrreversible if not treated early"), ("20", CAT_B, colors.HexColor("#E3F2FD"), "Prognosis", "REMISSION POSSIBLE (30–40%)\nAfter 1–2 years of ATD therapy\nHigher relapse rate than adults\nMay need surgery or RAI ultimately\n(lifelong monitoring)", "EXCELLENT if treated early\nNormal intellect and development\nif T4 started within 2 weeks of birth\nLifelong T4 needed, but full normal life\n(>90% normal IQ with early treatment)"), ] # ── BUILD TABLE ROWS ──────────────────────────────────────────── num_s_red = sty("NR", fontSize=10, fontName="Helvetica-Bold", textColor=WHITE, leading=14, alignment=TA_CENTER) table_rows = [] for (num, cat, bg, feat, hyper, hypo) in rows: # determine number badge colour by category badge_col = HYPER_MID if cat.startswith("🔬") else \ HYPO_MID if cat.startswith("💊") else \ colors.HexColor("#78909C") if cat.startswith("👶") else \ colors.HexColor("#AB47BC") if cat.startswith("⚠️") else \ colors.HexColor("#26A69A") if cat.startswith("🧬") else \ colors.HexColor("#FF7043") row = [ p(num, num_s), p(cat, cat_s), p("<b>" + feat.replace("\n","<br/>") + "</b><br/>" + hyper.replace("\n","<br/>"), cell_s), p(hypo.replace("\n","<br/>"), cell_s), ] table_rows.append((row, bg, badge_col)) # Render all_rows_data = [r[0] for r in table_rows] main_tbl = Table(all_rows_data, colWidths=COL_W, repeatRows=0) style_cmds = [ ("VALIGN", (0,0), (-1,-1), "TOP"), ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING", (0,0), (-1,-1), 6), ("LEFTPADDING", (0,0), (-1,-1), 5), ("RIGHTPADDING", (0,0), (-1,-1), 5), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#DDDDDD")), ("LINEAFTER", (1,0), (1,-1), 1.0, colors.HexColor("#BBBBBB")), ("LINEAFTER", (2,0), (2,-1), 1.2, colors.HexColor("#EF9A9A")), # red divider ] for i, (row, bg, badge) in enumerate(table_rows): style_cmds.append(("BACKGROUND", (0,i),(0,i), badge)) style_cmds.append(("BACKGROUND", (1,i),(1,i), colors.HexColor("#F5F5F5"))) style_cmds.append(("BACKGROUND", (2,i),(2,i), HYPER_LIGHT if i%2==0 else colors.HexColor("#FFF5F5"))) style_cmds.append(("BACKGROUND", (3,i),(3,i), HYPO_LIGHT if i%2==0 else colors.HexColor("#F5F9FF"))) style_cmds.append(("TEXTCOLOR", (0,i),(0,i), WHITE)) main_tbl.setStyle(TableStyle(style_cmds)) story.append(main_tbl) story.append(Spacer(1, 10)) # ════════════════════════════════════════════════════════════════ # GOLDEN RULES BOX # ════════════════════════════════════════════════════════════════ gold_data = [ [Paragraph("⭐ THE GOLDEN CLINICAL RULES ⭐", gold_rule)], [Paragraph( "<b>🔴 Think HYPERTHYROIDISM (Graves'):</b> Anxious, thin, sweaty OLDER GIRL " "with goitre, tachycardia, exophthalmos, tremor and weight loss despite eating well.", cell_s)], [Paragraph( "<b>🔵 Think CONGENITAL HYPOTHYROIDISM:</b> 'Too-good' NEONATE — sleepy, constipated, " "floppy, cold with umbilical hernia, prolonged jaundice and large tongue. " "<b>Missed on NBS = lifelong intellectual disability.</b>", cell_s)], [Paragraph( "<b>KEY BIOCHEMISTRY RULE:</b> TSH ↑ + T4 ↓ = Hypothyroid | TSH ↓ + T4 ↑ = Hyperthyroid", bold_cell)], [Paragraph( "<b>TREATMENT EMERGENCY:</b> Congenital hypothyroidism MUST be treated within the " "first 2 weeks of life to prevent irreversible brain damage. " "No other paediatric endocrine condition is this time-critical.", cell_s)], ] gold_tbl = Table(gold_data, colWidths=[W]) gold_tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0),(0,0), colors.HexColor("#F9A825")), ("BACKGROUND", (0,1),(0,1), HYPER_LIGHT), ("BACKGROUND", (0,2),(0,2), HYPO_LIGHT), ("BACKGROUND", (0,3),(0,3), colors.HexColor("#F3E5F5")), ("BACKGROUND", (0,4),(0,4), colors.HexColor("#FFFDE7")), ("BOX", (0,0),(-1,-1), 1.5, GOLD), ("LINEBELOW", (0,0),(0,0), 0.8, GOLD), ("TOPPADDING", (0,0),(-1,-1), 7), ("BOTTOMPADDING",(0,0),(-1,-1), 7), ("LEFTPADDING", (0,0),(-1,-1), 10), ("RIGHTPADDING",(0,0),(-1,-1), 10), ])) story.append(gold_tbl) story.append(Spacer(1, 6)) # ── FOOTER ────────────────────────────────────────────────────── footer_s = sty("Footer", fontSize=7.5, fontName="Helvetica-Oblique", textColor=MID_GREY, leading=11, alignment=TA_CENTER) story.append(Paragraph( "Sources: Tietz Textbook of Laboratory Medicine 7e • Harrison's Principles of Internal Medicine 22e " "• Creasy & Resnik's Maternal-Fetal Medicine • Current Surgical Therapy 14e • Goodman & Gilman's Pharmacological Basis " "• Fischer's Mastery of Surgery 8e | Generated by Orris AI — August 2026", footer_s)) # ── BUILD ──────────────────────────────────────────────────────── doc.build(story) print("PDF generated:", OUTPUT) PYEOF