---
title: Thyroid Initial Visit
emoji: 🦋
colorFrom: pink
colorTo: indigo
sdk: gradio
sdk_version: 5.5.0
python_version: "3.11"
app_file: app.py
pinned: false
license: mit
---

# Thyroid Initial-Visit Note Generator

4-section structured note for thyroid initial visit at endocrine / family-medicine outpatient, generated from form input. Phenotype-driven order selection (hyperthyroid / hypothyroid / goiter-nodule / abnormal-lab). Built-in ACR TI-RADS calculator on Tab 2.

## Output structure

1. 🚨 **Red flags** (conditional — only shown when triggered: thyroid storm, myxedema coma, airway compromise, suspicious malignancy on exam, sight-threatening Graves orbitopathy)
2. **History + ROS narrative** (phenotype-aware, includes meds/exposures and women-specific data)
3. **Physical examination** findings
4. **Initial workup plan**: A) checklist of suggested orders B) one-line narrative for HIS paste C) patient instructions D) brief differential and assessment thinking

Phenotype-driven Section 4 orders:
- Hyper → TSH, FT4, T3, TRAb, CBC, AST/ALT/bili (baseline before ATD), ECG
- Hypo → TSH, FT4, anti-TPO, ± anti-Tg, lipid, CBC, Na/Cr
- Goiter/nodule → US, cervical LN US, ± thyroid scan if TSH suppressed
- Abnormal lab → repeat in 4-6 weeks + conditional antibodies

## Tab 2: ACR TI-RADS calculator

Pure local calculation (no API call). Inputs: composition / echogenicity / shape / margin / echogenic foci (multi-select, additive) + nodule size. Outputs TR1-5 category + size-based FNA / follow-up recommendation per ACR TI-RADS 2017.

## Setup

Required Space secrets (Settings → Variables and secrets):

- `ANTHROPIC_API_KEY` — Claude API key
- `GDRIVE_CLIENT_ID` — Google OAuth client ID (desktop type)
- `GDRIVE_CLIENT_SECRET` — Google OAuth client secret
- `GDRIVE_REFRESH_TOKEN` — obtained via `python get_refresh_token.py` locally

Optional:

- `THYROID_PASSWORD` — Gradio basic-auth password (username: `doctor`)
- `GDRIVE_FOLDER_NAME` — default `Thyroid Initial Visits`
- `THYROID_MODEL` — default `claude-sonnet-4-6`

Without the three `GDRIVE_*` secrets, GDrive sync is disabled; manual `.md` download still works.

## Local run

```bash
pip install -r requirements.txt
export ANTHROPIC_API_KEY=sk-ant-...
python app.py
```

> Not for clinical use without physician verification.