First of all Tsunade has never done anything of any value. Aside of getting her ass handed to her by Kabuto. And summon a slug which was quickly owned by manda. She has incredible physical strength for a chick. Jiraiya and Orochimaru are both more powerful. Gai,Lee,Kakashi,Sarutobi can open Gates, so they are all stronger. Itachi is certainly stronger, but since we have never seen him actually TRY during a fight we just havent seen it yet. Not to mention that Itachi probably knows how to use the Gates also considering he could have easily copied it over the years.
So in the end, Tsunade is probably like the 10th strongest person on the show.
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