The aim of the present study was to analyze the relation of low or high serum thyrotropin (TSH) with mortality in patients with invasively treated coronary artery disease. We followed-up 942 patients who underwent coronary angioplasties or coronary artery bypass graft surgery over a mean follow-up period of 6.4+/-1.6 years. The study population was divided into three groups using the reference limits of serum TSH (0.25-2.12 mIU/l) as cut-offs. There were 118 patients (12.5%) with low and 125 patients (13.3%) with high serum TSH. One hundred and seventy-four subjects (18.5%) deceased during follow-up. Multivariable analyses revealed that both subjects with low and high serum TSH had a lower all-cause and circulatory mortality than subjects with serum TSH within the reference range. We conclude that low and high serum TSH levels are associated with a reduced all-cause and circulatory mortality in patients with coronary artery disease.