Given the potentially life-threatening sequelae of AST, the threshold for performing ultrasound-guided FNA to rule in/out AST should be relatively low, especially in a patient with one or more predisposing factors. Ideally, thyroid FNA cultures should be obtained prior to antibiotic administration to prevent unnecessary treatment and reduce the risk of a false-negative thyroid culture. Nevertheless, the patient in this case was treated empirically with ampicillin-sulbactam prior to obtaining a thyroid FNA a few days into her hospital stay. Had ampicillin-sulbactam not been started early on in her hospital stay, the thyroid mass may have further compressed the trachea, leading to significant narrowing and airway compromise.