This study assessed the efficacy of combining laser ablation treatment (LAT) and radioactive iodine 131 (131I) treatment for large thyroid toxic nodules. Fifteen patients received LAT followed by 131I (Group A), while 17 control patients received 131I only (Group B). Group A saw faster reduction in nodule volume and required lower 131I activities. At 24 months, nodule volume was reduced 71.3% in Group A versus 29.4% in Group B. Combining LAT with 131I provided improved outcomes over 131I alone for treatment of large toxic thyroid nodules.