import json, subprocess, base64
from io import BytesIO
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

# ── Colour palette ──────────────────────────────────────────────
TEAL        = RGBColor(0x00, 0x7A, 0x87)   # header bars
TEAL_LIGHT  = RGBColor(0xE0, 0xF5, 0xF8)   # subtle background tint
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
DARK_GREY   = RGBColor(0x1A, 0x1A, 0x2E)
MID_GREY    = RGBColor(0x44, 0x44, 0x55)
GOLD        = RGBColor(0xF0, 0xA5, 0x00)
LIGHT_BG    = RGBColor(0xF4, 0xF9, 0xFB)

W = Inches(13.333)
H = Inches(7.5)

prs = Presentation()
prs.slide_width  = W
prs.slide_height = H
blank = prs.slide_layouts[6]   # fully blank

# ────────────────────────────────────────────────────────────────
# Helper utilities
# ────────────────────────────────────────────────────────────────
def add_rect(slide, x, y, w, h, fill=None, line=None):
    from pptx.util import Emu
    shape = slide.shapes.add_shape(
        1,   # MSO_SHAPE_TYPE.RECTANGLE
        x, y, w, h
    )
    shape.line.fill.background()
    if fill:
        shape.fill.solid()
        shape.fill.fore_color.rgb = fill
    else:
        shape.fill.background()
    if line:
        shape.line.color.rgb = line
        shape.line.width = Pt(1)
    else:
        shape.line.fill.background()
    return shape

def add_text(slide, text, x, y, w, h,
             size=18, bold=False, color=DARK_GREY,
             align=PP_ALIGN.LEFT, wrap=True, italic=False):
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Inches(0.05)
    tf.margin_right = Inches(0.05)
    tf.margin_top  = Inches(0.02)
    tf.margin_bottom = Inches(0.02)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.name  = "Calibri"
    run.font.size  = Pt(size)
    run.font.bold  = bold
    run.font.italic = italic
    run.font.color.rgb = color
    return tf

def add_bullets(slide, items, x, y, w, h, size=15, color=DARK_GREY, indent=True):
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left  = Inches(0.1)
    tf.margin_right = Inches(0.05)
    tf.margin_top   = Inches(0.02)
    tf.margin_bottom= Inches(0.02)
    for i, item in enumerate(items):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.alignment = PP_ALIGN.LEFT
        if indent and item.startswith("  "):
            p.level = 1
            txt = item.strip()
            bullet_char = "◦  "
        else:
            p.level = 0
            txt = item.lstrip("- •")
            bullet_char = "●  "
        run = p.add_run()
        run.text = bullet_char + txt
        run.font.name  = "Calibri"
        run.font.size  = Pt(size)
        run.font.color.rgb = color
    return tf

def fetch_image_b64(url):
    result = json.loads(subprocess.check_output(
        ["python", "/tmp/skills/shared/scripts/fetch_images.py", url]
    ))
    return result[0]["base64"] if result and result[0]["base64"] else None

def add_image_from_url(slide, url, x, y, w, h):
    b64 = fetch_image_b64(url)
    if not b64:
        return
    mime, data = b64.split(";base64,", 1)
    raw = base64.b64decode(data)
    buf = BytesIO(raw)
    slide.shapes.add_picture(buf, x, y, width=w, height=h)

def slide_header(slide, title, subtitle=None):
    # full-width teal header bar
    add_rect(slide, 0, 0, W, Inches(1.1), fill=TEAL)
    add_text(slide, title,
             Inches(0.4), Inches(0.1), Inches(12.5), Inches(0.8),
             size=30, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_text(slide, subtitle,
                 Inches(0.4), Inches(0.82), Inches(12.5), Inches(0.35),
                 size=13, bold=False, color=TEAL_LIGHT, align=PP_ALIGN.LEFT, italic=True)
    # thin gold accent line under header
    add_rect(slide, 0, Inches(1.1), W, Pt(4), fill=GOLD)
    # light background fill for content area
    add_rect(slide, 0, Inches(1.14), W, H - Inches(1.14), fill=LIGHT_BG)

def footer_ref(slide, text):
    add_text(slide, text,
             Inches(0.3), Inches(7.1), Inches(12.7), Inches(0.35),
             size=9, italic=True, color=MID_GREY, align=PP_ALIGN.LEFT)


# ════════════════════════════════════════════════════════════════
# SLIDE 1 – Title
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)

# full teal background
add_rect(slide, 0, 0, W, H, fill=TEAL)

# large circle accent (decorative)
from pptx.util import Inches as I
circle = slide.shapes.add_shape(9, I(9.5), I(-1.5), I(5), I(5))  # oval
circle.fill.solid(); circle.fill.fore_color.rgb = RGBColor(0x00, 0x5F, 0x6B)
circle.line.fill.background()

# title text
add_text(slide, "Thyroid Investigation",
         I(0.8), I(1.8), I(10), I(1.6),
         size=52, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
add_text(slide, "A Surgical & Clinical Perspective",
         I(0.8), I(3.5), I(9), I(0.7),
         size=22, bold=False, color=TEAL_LIGHT, italic=True)
add_rect(slide, I(0.8), I(4.3), I(3.5), Pt(4), fill=GOLD)

add_text(slide, "Reference Sources:",
         I(0.8), I(4.6), I(11), I(0.4),
         size=13, color=TEAL_LIGHT)
add_text(slide, "• Bailey and Love's Short Practice of Surgery, 28th Edition",
         I(0.8), I(5.0), I(11), I(0.4),
         size=14, bold=False, color=WHITE)
add_text(slide, "• Sabiston Textbook of Surgery, The Biological Basis of Modern Surgical Practice",
         I(0.8), I(5.45), I(11), I(0.4),
         size=14, bold=False, color=WHITE)

add_text(slide, "July 2026",
         I(0.8), I(6.6), I(5), I(0.4),
         size=13, color=TEAL_LIGHT)


# ════════════════════════════════════════════════════════════════
# SLIDE 2 – Overview / Why Investigate?
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "Why Investigate the Thyroid?", "Clinical indications for thyroid workup")

add_bullets(slide,
    [
        "Thyroid disease is the second most common endocrine disorder after diabetes mellitus",
        "Clinical assessment alone is often insufficient — biochemical and imaging workup is mandatory",
        "Investigations guide diagnosis of: goitre, nodules, hyper/hypothyroidism, and malignancy",
        "Surgeon's perspective: investigations determine operability, surgical approach and extent",
        "Essential investigations vs optional investigations must be clearly distinguished",
    ],
    I(0.5), I(1.3), I(12.3), I(5.5),
    size=17, color=DARK_GREY
)

footer_ref(slide, "Bailey & Love's Surgery 28e, Ch.55 | Sabiston Textbook of Surgery, Ch.73")


# ════════════════════════════════════════════════════════════════
# SLIDE 3 – Classification of Investigations
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "Classification of Thyroid Investigations")

# Box 1: Biochemical
add_rect(slide, I(0.35), I(1.3), I(5.8), I(2.7), fill=WHITE, line=TEAL)
add_text(slide, "BIOCHEMICAL", I(0.4), I(1.3), I(5.7), I(0.5),
         size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
r2 = slide.shapes[-1]
add_rect(slide, I(0.35), I(1.3), I(5.8), I(0.45), fill=TEAL)
add_text(slide, "BIOCHEMICAL", I(0.4), I(1.3), I(5.7), I(0.45),
         size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

add_bullets(slide,
    ["Serum TSH", "  Free T3 and Free T4", "Thyroid autoantibodies (TPO-Ab, TgAb, TRAb)",
     "  Thyroglobulin (post-thyroidectomy)", "  Calcitonin (for medullary carcinoma)"],
    I(0.5), I(1.8), I(5.5), I(2.1), size=14)

# Box 2: Cytology / Histology
add_rect(slide, I(6.4), I(1.3), I(6.55), I(2.7), fill=WHITE, line=GOLD)
add_rect(slide, I(6.4), I(1.3), I(6.55), I(0.45), fill=GOLD)
add_text(slide, "CYTOLOGY / HISTOLOGY", I(6.45), I(1.3), I(6.4), I(0.45),
         size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Fine Needle Aspiration Cytology (FNAC)", "  Gold standard for thyroid nodule evaluation",
     "  Bethesda classification system used to report",
     "Core needle biopsy (selected cases)"],
    I(6.55), I(1.8), I(6.2), I(2.1), size=14)

# Box 3: Imaging
add_rect(slide, I(0.35), I(4.2), I(5.8), I(2.85), fill=WHITE, line=TEAL)
add_rect(slide, I(0.35), I(4.2), I(5.8), I(0.45), fill=TEAL)
add_text(slide, "IMAGING", I(0.4), I(4.2), I(5.7), I(0.45),
         size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Ultrasonography (USG) — workhorse", "Isotope/Radionuclide Scan (Tc-99m / I-123)",
     "CT scan", "MRI", "Chest X-Ray (retrosternal goitre)", "PET scan (selected cases)"],
    I(0.5), I(4.7), I(5.5), I(2.3), size=14)

# Box 4: Genetic
add_rect(slide, I(6.4), I(4.2), I(6.55), I(2.85), fill=WHITE, line=GOLD)
add_rect(slide, I(6.4), I(4.2), I(6.55), I(0.45), fill=GOLD)
add_text(slide, "GENETIC & MOLECULAR", I(6.45), I(4.2), I(6.4), I(0.45),
         size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["BRAF mutation (papillary carcinoma)",
     "RET proto-oncogene (medullary carcinoma / MEN2)",
     "RAS / PAX8-PPARγ (follicular carcinoma)",
     "Molecular testing on FNA samples (Afirma, ThyroSeq)"],
    I(6.55), I(4.7), I(6.2), I(2.3), size=14)

footer_ref(slide, "Bailey & Love's Surgery 28e | Sabiston Textbook of Surgery")


# ════════════════════════════════════════════════════════════════
# SLIDE 4 – Serum TSH
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "Thyroid Function Tests — Serum TSH",
             "The single most sensitive and reliable first-line test")

# Left content
add_bullets(slide,
    [
        "TSH: 28-kDa glycoprotein secreted by anterior pituitary",
        "Follows circadian rhythm; measured by 3rd/4th-generation ultrasensitive radioimmunoassay",
        "Normal range: 0.4 – 4.12 mIU/L (adult); sensitivity up to 97%",
        "Negative feedback from T3/T4 on TSH follows a log-linear relationship",
        "  → Small changes in thyroid hormone = large TSH swings",
        "Most common screening test for thyroid dysfunction",
        "Must interpret TSH alongside free T4 (and free T3 in select cases)",
        "Caution: falsely altered by pregnancy, euthyroid sick syndrome,",
        "  glucocorticoids, furosemide, anticonvulsants, metformin, amiodarone",
    ],
    I(0.5), I(1.25), I(7.5), I(5.5),
    size=15, color=DARK_GREY
)

# Right: TFT table
add_rect(slide, I(8.2), I(1.3), I(4.8), I(5.6), fill=WHITE, line=TEAL)
add_rect(slide, I(8.2), I(1.3), I(4.8), I(0.45), fill=TEAL)
add_text(slide, "TFT Interpretation (Bailey & Love Table 55.1)",
         I(8.25), I(1.3), I(4.7), I(0.45),
         size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

rows = [
    ("State",          "TSH",            "Free T4",  "Free T3"),
    ("Euthyroid",      "Normal",         "Normal",   "Normal"),
    ("Thyrotoxic",     "Undetectable",   "High",     "High"),
    ("Myxoedema",      "High",           "Low",      "Low"),
    ("T4 therapy",     "Undetectable",   "High",     "High/Normal"),
    ("T3 toxicosis",   "Low/Undetect.",  "Normal",   "High"),
]
row_h = Inches(0.66)
col_w = [Inches(1.5), Inches(1.1), Inches(1.1), Inches(1.1)]
col_x = [I(8.25), I(9.75), I(10.85), I(11.95)]
for ri, row in enumerate(rows):
    y = I(1.78) + ri * row_h
    bg = TEAL if ri == 0 else (RGBColor(0xE8,0xF7,0xFA) if ri % 2 == 0 else WHITE)
    for ci, (cell, cw, cx) in enumerate(zip(row, col_w, col_x)):
        add_rect(slide, cx, y, cw, row_h, fill=bg, line=TEAL_LIGHT)
        fc = WHITE if ri == 0 else DARK_GREY
        add_text(slide, cell, cx + Inches(0.03), y + Inches(0.05),
                 cw - Inches(0.06), row_h - Inches(0.1),
                 size=11, bold=(ri == 0), color=fc, align=PP_ALIGN.CENTER)

footer_ref(slide, "Sabiston Ch.73 (Thyroid Biomarkers) | Bailey & Love 28e, Table 55.1")


# ════════════════════════════════════════════════════════════════
# SLIDE 5 – Free T3 / T4 & Autoantibodies
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "Free T3, Free T4 & Thyroid Autoantibodies")

# Left column
add_rect(slide, I(0.3), I(1.25), I(6.2), I(2.8), fill=WHITE, line=TEAL)
add_rect(slide, I(0.3), I(1.25), I(6.2), I(0.4), fill=TEAL)
add_text(slide, "Serum Thyroid Hormones (T3 & T4)",
         I(0.35), I(1.25), I(6.1), I(0.4),
         size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    [">99.8% of T3 & T4 is protein-bound; only free fractions are biologically active",
     "Free T4 is preferred over total T4 for accuracy",
     "Free T3: useful for hyperthyroidism confirmation and euthyroid sick syndrome",
     "TSH + Free T4 = most commonly paired tests for thyroid dysfunction monitoring",
     "Normal ranges are age-dependent (paediatric vs adult standards differ)"],
    I(0.45), I(1.7), I(6.0), I(2.3), size=14)

# Right column
add_rect(slide, I(6.85), I(1.25), I(6.15), I(2.8), fill=WHITE, line=GOLD)
add_rect(slide, I(6.85), I(1.25), I(6.15), I(0.4), fill=GOLD)
add_text(slide, "Thyroid Autoantibodies",
         I(6.9), I(1.25), I(6.05), I(0.4),
         size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Anti-TPO (TPOAb): most accurate screening test for autoimmune thyroiditis",
     "  Significant if > 25 U/mL (Bailey & Love)",
     "Anti-Thyroglobulin (TgAb): raised in Hashimoto's / Graves'",
     "  Significant titre > 1:100 (Bailey & Love)",
     "TRAb (TSH-receptor antibodies): diagnostic of Graves' disease",
     "  Protracted action 16–24 hr vs TSH 1.5–3 hr; responsible for virtually all non-nodular thyrotoxicosis"],
    I(7.0), I(1.7), I(5.9), I(2.3), size=14)

# Bottom section — Thyroglobulin & Calcitonin
add_rect(slide, I(0.3), I(4.2), I(6.2), I(2.8), fill=WHITE, line=TEAL)
add_rect(slide, I(0.3), I(4.2), I(6.2), I(0.4), fill=TEAL)
add_text(slide, "Thyroglobulin (Tg)",
         I(0.35), I(4.2), I(6.1), I(0.4),
         size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Most useful as post-thyroidectomy tumour marker for differentiated thyroid cancer (DTC)",
     "Undetectable Tg after total thyroidectomy = no residual / recurrent disease",
     "Must be interpreted alongside TgAb (TgAb can falsely suppress Tg measurement)"],
    I(0.45), I(4.65), I(6.0), I(2.3), size=14)

add_rect(slide, I(6.85), I(4.2), I(6.15), I(2.8), fill=WHITE, line=GOLD)
add_rect(slide, I(6.85), I(4.2), I(6.15), I(0.4), fill=GOLD)
add_text(slide, "Calcitonin",
         I(6.9), I(4.2), I(6.05), I(0.4),
         size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Secreted by parafollicular C cells of the thyroid",
     "Elevated in medullary thyroid carcinoma (MTC)",
     "CEA may be used as alternative screening marker for MTC",
     "Useful for screening RET proto-oncogene mutation carriers (MEN 2A/2B)"],
    I(7.0), I(4.65), I(5.9), I(2.3), size=14)

footer_ref(slide, "Sabiston Ch.73 | Bailey & Love 28e, Ch.55")


# ════════════════════════════════════════════════════════════════
# SLIDE 6 – FNAC
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "Fine Needle Aspiration Cytology (FNAC)",
             "Essential first-line investigation for all discrete thyroid swellings")

add_bullets(slide,
    [
        "FNAC is mandatory for all palpable discrete thyroid swellings — Bailey & Love",
        "Ultrasound-guided FNA is more accurate than free-hand technique",
        "  USG guidance allows precise targeting, reduces non-diagnostic samples",
        "Results reported using the Bethesda System for Reporting Thyroid Cytopathology:",
    ],
    I(0.5), I(1.25), I(12.5), I(2.5), size=16)

# Bethesda table
headers = ["Category", "Bethesda", "Description", "Malignancy Risk"]
beth = [
    ["I",  "Non-diagnostic / Unsatisfactory", "Insufficient cells", "1–4%"],
    ["II", "Benign", "Benign follicular / colloid / thyroiditis", "0–3%"],
    ["III","Atypia of undetermined significance (AUS)", "Indeterminate", "5–15%"],
    ["IV", "Follicular neoplasm", "Follicular lesion", "15–30%"],
    ["V",  "Suspicious for malignancy", "High suspicion", "60–75%"],
    ["VI", "Malignant", "PTC, MTC, anaplastic, lymphoma", "97–99%"],
]

rh = Inches(0.52)
cw = [Inches(0.7), Inches(1.1), Inches(5.2), Inches(2.1)]
cx = [I(0.4), I(1.15), I(2.3), I(7.55)]

for ri, row in enumerate([headers] + beth):
    y = I(3.9) + ri * rh
    bg = TEAL if ri == 0 else (RGBColor(0xE8,0xF7,0xFA) if ri % 2 == 0 else WHITE)
    for ci, (cell, w, x) in enumerate(zip(row, cw, cx)):
        add_rect(slide, x, y, w, rh, fill=bg, line=TEAL_LIGHT)
        fc = WHITE if ri == 0 else DARK_GREY
        add_text(slide, cell, x+I(0.03), y+I(0.03), w-I(0.06), rh-I(0.06),
                 size=12, bold=(ri==0), color=fc, align=PP_ALIGN.CENTER)

add_text(slide, "Repeat / Lobectomy / Hemithyroidectomy  →  Molecular testing if Bethesda III/IV",
         I(9.8), I(3.9), I(3.0), I(3.0),
         size=13, color=MID_GREY, wrap=True)

footer_ref(slide, "Sabiston Ch.73 | Bailey & Love 28e, Ch.55")


# ════════════════════════════════════════════════════════════════
# SLIDE 7 – Ultrasonography (with image)
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "Ultrasonography — The Workhorse Investigation",
             "First-line imaging for all thyroid disorders")

add_bullets(slide,
    [
        "Workhorse investigation for thyroid disease in the surgeon's practice (Bailey & Love)",
        "Assesses: gland size, echotexture, nodule characteristics, regional lymphatics",
        "Key nodule features evaluated: number, size, shape, margins, vascularity, microcalcifications",
        "Predicts malignancy risk — forms the basis of TI-RADS scoring",
        "USG-guided FNA improves accuracy vs free-hand technique",
        "Advantages: no ionising radiation, non-invasive, low cost",
        "Limitation: limited visualisation of central/retrosternal nodes",
    ],
    I(0.5), I(1.25), I(7.2), I(5.5),
    size=15, color=DARK_GREY
)

# TI-RADS mini table
add_rect(slide, I(7.9), I(1.3), I(5.1), I(3.5), fill=WHITE, line=TEAL)
add_rect(slide, I(7.9), I(1.3), I(5.1), I(0.4), fill=TEAL)
add_text(slide, "ACR TI-RADS Risk Categories",
         I(7.95), I(1.3), I(5.0), I(0.4),
         size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

tirads = [
    ("TR1 — Benign",          "Score 0",   "No FNA needed"),
    ("TR2 — Not Suspicious",  "Score 2",   "No FNA needed"),
    ("TR3 — Mildly Susp.",    "Score 3",   "FNA if ≥2.5 cm"),
    ("TR4 — Moderately Susp.","Score 4–6", "FNA if ≥1.5 cm"),
    ("TR5 — Highly Susp.",    "Score ≥7",  "FNA if ≥1 cm"),
]
rh2 = Inches(0.55)
for ri, (cat, score, action) in enumerate(tirads):
    y = I(1.73) + ri * rh2
    bg = RGBColor(0xE8,0xF7,0xFA) if ri % 2 == 0 else WHITE
    add_rect(slide, I(7.95), y, I(2.1), rh2, fill=bg, line=TEAL_LIGHT)
    add_rect(slide, I(10.05), y, I(1.1), rh2, fill=bg, line=TEAL_LIGHT)
    add_rect(slide, I(11.15), y, I(1.8), rh2, fill=bg, line=TEAL_LIGHT)
    add_text(slide, cat,   I(7.97), y+I(0.05), I(2.05), rh2-I(0.1), size=11, color=DARK_GREY)
    add_text(slide, score, I(10.07),y+I(0.05), I(1.05), rh2-I(0.1), size=11, color=DARK_GREY, align=PP_ALIGN.CENTER)
    add_text(slide, action,I(11.17),y+I(0.05), I(1.75), rh2-I(0.1), size=11, color=DARK_GREY)

# Add USG image
try:
    add_image_from_url(slide,
        "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_33f2b2a2b292ab516a3f3e5fb49a5b09e80fbd956ff6533bac4524933fc4cb71.jpg",
        I(7.9), I(4.95), I(5.1), I(2.1))
    add_text(slide, "USG: Solid hyperechoic thyroid nodule (TR3 — mildly suspicious)",
             I(7.9), I(7.1), I(5.1), I(0.3), size=9, color=MID_GREY, italic=True, align=PP_ALIGN.CENTER)
except Exception as e:
    print(f"USG image failed: {e}")

footer_ref(slide, "Bailey & Love 28e, Ch.55 | Sabiston Ch.73 (Thyroid Imaging)")


# ════════════════════════════════════════════════════════════════
# SLIDE 8 – Isotope Scan
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "Radionuclide / Isotope Scan",
             "Tc-99m pertechnetate | I-123 | I-131")

add_bullets(slide,
    [
        "Indications (Bailey & Love): discrete swelling + thyrotoxicosis coexist",
        "Largely rendered obsolete by high-resolution USG for most scenarios (Sabiston)",
        "",
        "Hot nodule: increased uptake — 'autonomous' hyperfunctioning; extremely low malignancy risk",
        "Cold nodule: decreased uptake — ~15% risk of malignancy",
        "Warm nodule: equal uptake to surrounding tissue",
        "",
        "Key uses today:",
        "  1. Differentiate Graves' disease (diffuse uptake) vs toxic adenoma (focal hot nodule)",
        "  2. Tc-99m or I-123 for initial scanning; I-131 for RAI therapy",
        "  3. Post-thyroidectomy whole-body scan to detect metastatic differentiated thyroid cancer",
        "  4. Assess residual thyroid tissue after ablation",
    ],
    I(0.5), I(1.25), I(7.2), I(5.9),
    size=15, color=DARK_GREY
)

try:
    add_image_from_url(slide,
        "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_918e5d8dba2af1d9708e0d72b4da0cfd21d532a95db96ddae0a464d94ab9a955.jpg",
        I(7.9), I(1.3), I(5.1), I(5.8))
    add_text(slide, "Isotope scan: hot nodule (right lobe) with suppressed contralateral tissue — toxic adenoma",
             I(7.9), I(7.1), I(5.1), I(0.3), size=9, color=MID_GREY, italic=True, align=PP_ALIGN.CENTER)
except Exception as e:
    print(f"Isotope image failed: {e}")

footer_ref(slide, "Bailey & Love 28e, Ch.55 | Sabiston Ch.73")


# ════════════════════════════════════════════════════════════════
# SLIDE 9 – CT / MRI / CXR
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "CT, MRI & Chest X-Ray",
             "Cross-sectional imaging for selected indications")

# Left — CT
add_rect(slide, I(0.3), I(1.25), I(6.2), I(5.9), fill=WHITE, line=TEAL)
add_rect(slide, I(0.3), I(1.25), I(6.2), I(0.45), fill=TEAL)
add_text(slide, "CT Scan", I(0.35), I(1.25), I(6.1), I(0.45),
         size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Preferred cross-sectional modality for thyroid surgeons (easier interpretation vs MRI)",
     "Key indications:",
     "  • Substernal (intrathoracic) goitre — defines inferior extent",
     "  • Advanced thyroid cancer — invasion of trachea, oesophagus, vessels",
     "  • Cervical lymph node metastases (superior to MRI)",
     "  • Craniocaudal scan: skull base → tracheal bifurcation",
     "Non-contrast CT: sufficient for retrosternal goitre assessment",
     "Contrast-enhanced CT: needed for locally advanced cancer / bulky lymph nodes",
     "On non-contrast CT: thyroid appears hyperattenuating vs surrounding muscles"],
    I(0.45), I(1.75), I(6.0), I(5.3), size=14)

# Right — MRI + CXR
add_rect(slide, I(6.85), I(1.25), I(6.15), I(2.7), fill=WHITE, line=GOLD)
add_rect(slide, I(6.85), I(1.25), I(6.15), I(0.45), fill=GOLD)
add_text(slide, "MRI", I(6.9), I(1.25), I(6.05), I(0.45),
         size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["T1/T2-weighted: thyroid mildly hyperintense; bright gadolinium enhancement",
     "Role: complementary to CT for invasive thyroid cancer",
     "Useful for vascular anomaly detection (e.g. lusoria artery → non-RLN risk)",
     "Superior soft-tissue contrast for aerodigestive tract invasion"],
    I(7.0), I(1.75), I(5.9), I(2.3), size=14)

add_rect(slide, I(6.85), I(4.1), I(6.15), I(3.05), fill=WHITE, line=TEAL)
add_rect(slide, I(6.85), I(4.1), I(6.15), I(0.45), fill=TEAL)
add_text(slide, "Chest X-Ray (CXR)", I(6.9), I(4.1), I(6.05), I(0.45),
         size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Predicts retrosternal extension",
     "Demonstrates tracheal deviation / compression",
     "Identifies calcification in a large goitre",
     "PET Scan: used for Tg-positive / RAI-negative DTC patients",
     "  → Detects metabolically active disease"],
    I(7.0), I(4.6), I(5.9), I(2.5), size=14)

footer_ref(slide, "Sabiston Ch.73 (Cross-Sectional Imaging) | Bailey & Love 28e, Ch.55")


# ════════════════════════════════════════════════════════════════
# SLIDE 10 – Essential vs Optional Summary
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
slide_header(slide, "Summary: Essential vs Optional Investigations",
             "Bailey & Love's Framework — Ch. 55")

add_rect(slide, I(0.3), I(1.25), I(6.1), I(5.9), fill=WHITE, line=TEAL)
add_rect(slide, I(0.3), I(1.25), I(6.1), I(0.5), fill=TEAL)
add_text(slide, "✔  ESSENTIAL", I(0.35), I(1.25), I(6.0), I(0.5),
         size=15, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Serum TSH",
     "  (Free T3 and Free T4 if TSH is abnormal)",
     "Thyroid autoantibodies",
     "Fine Needle Aspiration Cytology (FNAC) of palpable discrete swellings"],
    I(0.45), I(1.8), I(5.9), I(5.3), size=16)

add_rect(slide, I(6.85), I(1.25), I(6.15), I(5.9), fill=WHITE, line=GOLD)
add_rect(slide, I(6.85), I(1.25), I(6.15), I(0.5), fill=GOLD)
add_text(slide, "◉  OPTIONAL", I(6.9), I(1.25), I(6.05), I(0.5),
         size=15, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_bullets(slide,
    ["Corrected serum calcium",
     "Serum calcitonin (or CEA as alternative for medullary cancer screening)",
     "Imaging:",
     "  • CXR / thoracic inlet — tracheal deviation / retrosternal goitre",
     "  • CT / MRI — known cancer, reoperations, retrosternal goitre",
     "  • Isotope scan — discrete swelling + thyrotoxicosis coexist",
     "Genetic / molecular testing (BRAF, RET, RAS, Afirma, ThyroSeq)"],
    I(7.0), I(1.8), I(5.9), I(5.3), size=16)

footer_ref(slide, "Bailey & Love's Short Practice of Surgery 28e, Ch.55")


# ════════════════════════════════════════════════════════════════
# SLIDE 11 – Key Take-Away / References
# ════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, W, H, fill=TEAL)
add_rect(slide, 0, 0, W, Inches(1.2), fill=RGBColor(0x00, 0x5F, 0x6B))

add_text(slide, "Key Clinical Points & References",
         I(0.5), I(0.2), I(12.3), I(0.9),
         size=28, bold=True, color=WHITE)

add_rect(slide, I(0.3), I(1.35), I(12.7), Pt(3), fill=GOLD)

pts = [
    "1.  TSH is the single best initial screening test — a suppressed TSH mandates further evaluation for thyrotoxicosis.",
    "2.  FNAC is essential for all discrete thyroid swellings and is the cornerstone of pre-operative cancer diagnosis.",
    "3.  Ultrasonography is the imaging workhorse — USG-guided FNA is preferred over free-hand.",
    "4.  Isotope scans are now largely reserved for: Graves' vs toxic adenoma differentiation and post-thyroidectomy RAI surveillance.",
    "5.  CT is the preferred cross-sectional modality for substernal goitre and locally advanced thyroid cancer.",
    "6.  Autoantibodies (TPOAb, TgAb, TRAb) help differentiate autoimmune thyroid disorders.",
    "7.  Calcitonin / RET mutation testing is mandatory when medullary carcinoma is suspected.",
]
for i, pt in enumerate(pts):
    add_text(slide, pt, I(0.5), I(1.5) + i * Inches(0.73),
             I(12.3), I(0.68), size=14, color=WHITE)

add_rect(slide, I(0.3), I(6.7), I(12.7), Pt(2), fill=GOLD)
add_text(slide,
         "References:  Bailey and Love's Short Practice of Surgery, 28th Ed., Ch. 55  |  "
         "Sabiston Textbook of Surgery (Biological Basis of Modern Surgical Practice), Ch. 73 — The Thyroid",
         I(0.3), I(6.75), I(12.7), I(0.65),
         size=11, italic=True, color=TEAL_LIGHT)

# ── Save ────────────────────────────────────────────────────────
out_path = "/tmp/workspace/thyroid-pptx/Thyroid_Investigation.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/build_pptx.py'