A 25-year-old woman presented to the emergency department with a 2-week history of progressively increasing neck swelling associated with pain, dysphagia, and orthopnea. On examination, hervitals were normal. A fluctuant, tender 3.4 cm mass was palpated in the right thyroid gland. Contrast-enhanced computed tomography of the neck showed marked enlargement of the thyroid lobe and the lateral aspect of the thyroid isthmus with diffusely decreased attenuation, multiple enhancing septations, and inflammatory changes in the surrounding soft tissues (image A, red arrow). The trachea was mildly displaced to the left (image B, blue arrow). The patient was treated with IV ampicillin-sulbactam and incision and drainage due to multiple septations, making adequate drainage with fine-needle aspiration difficult. Fluid cultures grew Streptococcus anginosus. The patient was stable upon posthospital follow-up with no further neck swelling.