Acute Suppurative Thyroiditis (AST), an infection of the thyroid caused by bacteria, fungi, or parasites, is a unique cause of thyroid disease. While the causative agents are usually gram-positive skin flora, cases due to atypical bacteria or fungi have been seen in susceptible patient populations. In adults, AST is usually attributed to trauma, fine needle aspiration of the thyroid, or an immunocompromised state usually due to organ transplant, HIV infection, or uncontrolled diabetes. If untreated, the morbidity and mortality of AST is high. We describe a case of AST in a patient whose only risk factor was uncontrolled type 2 diabetes mellitus where the presumed causative agent was extended-spectrum beta-lactamase producing E. coli, an exceedingly rare cause of AST. We discuss the commonly reported etiologies, risk factors, and hormonal dysfunction of this rare condition.