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Although multiple pathways are involved in mediating tissue damage, including the polyol pathway, advanced glycation end product formation, protein kinase C activation, and the hexosamine pathway, a common feature is increased oxidative stress marked by elevated levels of reactive oxygen species (ROS) (1)

Animal studies, particularly in rodents, have demonstrated that GLP-1 agonists can stimulate thyroid C-cell proliferation and, in some cases, lead to C-cell tumors (medullary thyroid carcinoma)

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