Aim Tuberculosis (TB)-associated thyroid abscess is an uncommon manifestation of extrapulmonary tuberculosis, posing diagnostic and therapeutic challenges. This review aims to evaluate current evidence regarding the clinical presentation, diagnostic approaches, and management strategies for TB-associated thyroid abscess. It also aims to evaluate the efficacy of anti-tubercular therapy (ATT) alongside surgical interventions to inform best practices and address gaps in standardized management protocols for this rare clinical entity. Methods A comprehensive literature search was conducted using databases such as PubMed, MEDLINE, and Scopus, focusing on articles published in the past 20 years. Keywords included "tuberculosis," "thyroid abscess," "management," and "treatment." Case reports, case series, and review articles were included to identify patterns in clinical presentation, diagnostic tools, and therapeutic interventions. Results A literature review identifies approximately 76 reported cases of thyroid tuberculosis between 1905 and 2004, with limited additional case reports in subsequent years. Of these, only a fraction involved abscess formation. Management primarily involves a combination of prolonged anti-tubercular therapy (6–12 months) and surgical interventions, such as incision and drainage or thyroidectomy, for larger abscesses or airway compromise. Prompt initiation of ATT significantly reduced complications and recurrence. Conclusion TB-associated thyroid abscess is a rare but treatable condition requiring high clinical suspicion for timely diagnosis. Early diagnosis with FNAC and microbiological analysis is central to confirming the diagnosis. The cornerstone for assisting in prompt recovery remains to be ATT. Surgical intervention is often reserved for severe or refractory cases.