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Nevertheless, redox cycling remains an understated mechanism of toxicity due to the fleeting existence of free radical intermediates which hinders their quantification in real time, both in vitro and in vivo 6

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However, published case reports and a 2024 retrospective cohort in Thyroid (N=112 patients on stable levothyroxine who started semaglutide) found that 28% required a TSH recheck within 6 months because of new hypothyroid symptoms or rising TSH, compared with 9% in a matched control group not starting GLP-1 therapy [7]

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