Thyroid Tuberculosis Abscess: A Systematic Review of Diagnostic Pathways and Management Strategies

Background: Thyroid tuberculosis abscesses (TTA) are rare manifestations of extrapulmonary tuberculosis, with the available literature consisting almost exclusively of individual case reports and small observational series. This systematic review aimed to evaluate current management strategies and associated clinical outcomes for TTA. Methods: Reports describing confirmed TTA, specified treatment regimens and clinical outcomes were systematically identified and synthesised from PubMed, Embase, Web of Science and Google Scholar from the period 1990 to 2025. Studies with suspected but unconfirmed cases were excluded. Risk of bias was assessed using the Joanna Briggs Institute tool. A total of 22 studies comprising 33 patients were included. Results: Significant diagnostic delays were seen. When diagnosis was established, standard four-drug anti-tubercular therapy (ATT) for at least 6 months emerged as the predominant first-line treatment. Surgical or percutaneous drainage procedures were typically reserved for large abscesses, treatment failure, acute suppurative presentations or suspected malignancy. Across published cases, lesion resolution and preservation of euthyroid function were reported in 92% of patients. However, the absence of comparative studies and the reliance on highly selected case material limit definitive conclusions and raise concerns about publication bias. Conclusions: TTA is a rare entity, with established treatment success with ATT, with surgery reserved for selected cases. Higher-quality comparative data are required to inform optimal management strategies.