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Dagmawi Anteneh Teferi,1 Ayto Addisu Negash,2 Daniel Aman,2 Sisay Hailu,2 Taye Nigatu Tola,1 Yared G/Michael Tarekegn,3 Wubhareg Anteneh Teferi4 1Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 4School of Medicine and Health Science, Wolkite University, Wolkite, EthiopiaCorrespondence: Dagmawi Anteneh Teferi, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Po.Box: 1271, Addis Ababa, Ethiopia, Email dagmawianteneh16@gmail.comBackground: Thyroid gland abscess is a rare pathology with life-threatening complications when there is a delay in diagnosis. However, physicians should be aware of and consider this differential in patients with anterior neck swelling having acute onset compressive symptoms to ensure early diagnosis and management.Case Presentation: A 62-year-old female patient presenting with worsening of painful anterior neck swelling with associated fever, shortness of breath, and difficulty swallowing. The patient was found to have a thyroid abscess causing upper airway obstruction, against a background of follicular nodular disease found on clinical examination, cytology and fluid analysis from aspirate, biopsy, ultrasonography, and computed tomography. The patient was managed with endotracheal intubation and was subsequently discharged after recovery with antibiotic therapy, incision and drainage, and thyroid lobectomy.Conclusion: Thyroid abscess is an uncommon, critical clinical condition with high morbidity and mortality. Thyroid gland abscess should be considered while evaluating patients presenting with acute onset anterior neck swelling. Satisfactory clinical outcomes could be achieved with early diagnosis and proper management.Keywords: thyroid abscess, thyroid emergency, upper airway obstruction, anterior neck mass, incision and drainage, thyroidectomy