Thyroid abscess is a rare encounter due to its unique histological and structural features. It is usually associated with some form of congenital anomalies in pediatrics especially if recurred. Early recognition and treatment are of paramount importance in preventing complications. Atypical presentation can occur if the patient is improperly treated prior to presentation. Conservative management is becoming the mainstay of treatment unless there is a risk of airway compromise or extension.We report the case of a 15-month-old female who presented with anterior neck swelling. She received oral antibiotics prior to her visit and did not exhibit severe systemic illness despite her disease extension. She was found to have a thyroid abscess originating from the left thyroid lobe extending to the mediastinum. No congenital anomalies were found. She was managed with open drainage and her cultures grew Streptococcus pyogenes.