Sažetak Acute suppurative thyroiditis is a rare but potentially life threatening disease in children and adolescents, usually occurring as a complication of so-called pyriform sinus fistula. The left thyroid lobe is affected in 90% of cases. Common treatment is a combination of surgical and antibiotic therapy, although good results of less invasive therapeutic approaches have been reported recently from non-randomized studies. We describe three female pediatric patients with acute purulent thyroiditis treated at our Department during a 20-year period, without confirmed sinus pyriform fistula. Two patients had a process in the right lobe of the thyroid, and all of them were treated with antibiotics and surgical therapy.