Abstract: AIM: To compare the efficacy between ¹³¹I and anti-thyroid drugs (ATD) for treatment of thyrotoxic cardiopathy. METHODS: Two hundred and twenty-six patients with thyrotoxic cardiopathy were treated, respectively, with ¹³¹I (151 cases) and ATD (75 cases). Efficacy, changes of thyroid hormones, and results of electrocardiogram and echocardiogram were compared between groups. RESULTS: The total effective rate of ¹³¹I group was higher than the ATD group (P<0.01) and the improvement of cardiac function and electrocardiogram in ¹³¹I group was better than that in ATD group (P<0.01). Significant improvement was found in the levels of LVEF, LVEDD, LVESD, SV and CO before and after treatment in ¹³¹I group (P<0.01). No significant difference was observed in the results of echocardiogram before and after treatment in ATD group and no significant difference was seen in the results of echocardiogram between groups (P<0.01). Obvious descent was observed in the level of thyroid hormones after treatment compared with that before treatment in each group (P<0.01). But no significant difference was observed after treatment between groups. The incidence of hypothyroidism in ¹³¹I group was higher than that in ATD group (17% vs. 0%, P<0.01). CONCLUSION: ¹³¹I is more effective than ATD in the treatment of thyrotoxic cardiopathy but with a higher incidence of hypothyroidism.