A 20-year-old Somali woman presented with a tender, enlarging neck mass in the setting of weight loss and tachycardia. This was initially thought to be a thyroid storm. On further investigation, she had suppurative thyroiditis from Mycobacterium tuberculosis. This case illustrates a high prevalence of extrapulmonary tuberculosis (TB) in foreign-born individuals and the necessity to consider TB in the differential diagnosis of an enlarging neck mass.