A 79-year-old woman with acute suppurative Salmonella thyroiditis is reported. She presented with fever and an enlarged, painful thyroid mass. Diagnosis was suspected by clinical symptoms and signs and confirmed by ultrasound, neck magnetic resonance imaging, aspiration cytology, and culture. The culture of fine-needle aspirate yielded Salmonella typhimurium. She was treated by parental antibiotics and surgical drainage. The source and route of infection remained unclear under a series of examinations. No piriform sinus fistula was evident on the imaging study. A hematogenous spread seems to be the most possible route.