Background: Acute suppurative thyroiditis leading to thyroid abscess (TA) is a rare but curable disease. It affects both pediatric and adult populations with distinctive predisposing conditions. The diagnosis should be made early with a high index of suspicion, and proper treatment should be instituted promptly to prevent serious complications. Study: A retrospective observational study of 15 cases of acute suppurative thyroiditis was undertaken in our surgical unit of SCB Medical College and Hospital, Cuttack, from 1998 to 2021. It was found that all cases were adult females with age ranging from 30 to 65 years. There were five abscesses that required incision and drainage out of which four cases persisted with residual goiter. One case had probable necrosis of the whole nodule. After the subsidence of inflammation, these four cases underwent thyroidectomy. Three were benign and one came out to be follicular cancer. Ten patients responded completely to conservative treatment. Pre-existing goiter was present in six cases and nine patients had a secondary immunodeficient state. One patient had a multiloculated diffuse abscess with skin necrosis and rupture. Conclusion: Acute suppurative thyroiditis and TA, though being an uncommon clinical entity requires meticulous attention to diagnosis and establishing the cause. Early institution of treatment prevents serious complications and recurrence. Pre-existing goitrous pathology and accompanying immunodeficiency state should be tackled together for a better outcome.