Tubercular involvement of the thyroid gland is a rare entity. Tuberculosis of thyroid gland can present as cold abscess, multinodular goitre, acute abscess or generalized goitre. Clinically, these patients can be euthyroid, hypothyroid or hyperthyroid. Diagnosis is made by fine needle aspiration and demonstration of acid fast bacilli. Here, we report the case of a 46-year-old male who presented with disseminated extrapulmonary tuberculosis with obstructive hydrocephalus and cold abscess of the thyroid gland. He was managed with anti-tubercular therapy and ventriculoperitoneal shunt for hydrocephalus. This report emphasizes the clinical importance of the rare presentation of a common disease in an endemic region.