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More rarely, GO can be found in patients with hypothyroid autoimmune thyroiditis or in subjects with subclinical evidence of thyroid autoimmunity, but with no thyroid dysfunction, and the pathogenesis of these conditions is still a matter of debate ( Oxidative Stress in Graves Orbitopathy Oxidative stress is defined as the disruption of the balance between the production and the elimination of reactive oxygen species (ROS), which causes a remarkable damage of several cell components, namely proteins, lipids, membranes, and nucleic acids ( Figure 1 )

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However, this evidence is derived from small observational studies and should be interpreted with caution