A 21-year-old female presented with history of fever, anterior neck swelling, and weight loss of 3.5 kg for 3-4 months. The family history was significant for tuberculosis in one brother. On examination, she had marked swelling of anterior neck with no lymphadenopathy. Clinically, she was euthyroid. The systemic examination was unremarkable. Her complete blood count was normal with an ESR of 25 mm/1st hour. Mantoux test was positive. The routine biochemistry were all within the normal limits. Biochemically, she was also euthyroid. Her Technetium 99 thyroid scintigraphy revealed cold nodule in the lower aspect of right thyroid lobe. 
Fine-needle aspiration cytology (FNAC) showed caseation necrosis, and pus from nodule did not show AFB, but pus culture was positive for Tubercle Bacilli. Therefore, she was started on antituberculous treatment (ATT) with four drugs regimen for first 3 months followed by 3 drugs regimen for the next 6 months. After treatment, she had complete resolution of swelling (Figures 1(a) and 1(b)).