By using the pre-ejection period (PEP), the left ventricular ejection time (LVET) and LVET/PEP ratio, cardiac function was investigated in 35 patients with Graves' disease (mild and severe), 13 patients with primary hypothyroidism and 35 normal subjects. The effect of treatment with antithyroid drugs, T4 or Co-Q10 was also evaluated. Before treatment, PEP was significantly shorter and the LVET/PEP ratio was greater in mild thyrotoxic patients than in the control subjects. PEP and LVET/PEP ratio returned to control levels after the euthyroid state was maintained with antithyroid drugs. In severe thyrotoxic patients, PEP and LVET/PEP ratio did not show any significant change compared with the control subjects, although LVET was significantly shorter. In hypothyroid patients, marked prolongation of PEP, shortening of LVET and decrease in LVET/PEP ratio were shown and returned to control levels after the euthyroid state was maintained with T4. PEP correlated curvilinearly with serum T3 and T4 concentrations. However, LVET/PEP ratio increased linearly from hypothyroid to mild thyrotoxic patients and decreased gradually in severe thyrotoxic patients. The inverse correlations between serum Co-Q10 and T3 and T4 concentrations were shown in patients suffering from hypothyroidism to mild thyrotoxicosis. After the administration of 120 mg Co-Q10 for 7 days in mild untreated thyrotoxic patients, a significant shortening of PEP and an increase in LVET/PEP ratio and stroke volume were shown. These data indicate that cardiac function in terms of PEP and LVET/PEP ratio is markedly influenced by serum thyroid hormone concentrations and Co-Q10 modulates it.