The guidelines of management of hyperthyroidism has been published by American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE) in 2011. This article introduced its key points related to 131I therapy for hyperthyroidism, and the advances of 131I in the treatment of hyperthyroidism at home and abroad in recent years. Our clinical experiences on 131I in the treatment of refractory severe hyperthyroidism without antithyroid drug pretreatment in China were highlighted particularly.