Kresimira M Milas

Interests

Teaching

Endocrine Surgery, Thyroid, Parathyroid, Adrenal, Hereditary Cancer Syndromes

Research

Molecular markers for thyroid cancer diagnosis, parathyroid diseases, PTEN

Courses

No activities entered.

Scholarly Contributions

Books

• Milas, K. (2017). Advanced Thyroid and Parathyroid Ultrasound. Springer.
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  This text provides a comprehensive review of ultrasound in thyroid and parathyroid diseases. These topics are presented from a vantage point of complex decision-making encountered in real clinical scenarios. The sections are organized according to a logical structure covering benign and malignant thyroid conditions, parathyroid disease, and ultrasound technology, ultrasound-guided interventions, and innovations. The style of the chapters provide practical, actionable information that is richly illustrated with figures and links to video cine-clips. The chapter topics aim to show how different specialists uniquely apply ultrasound in given clinical scenarios. The text illustrates the optimal incorporation of current practice guidelines, as this remains varied and inconsistent among clinicians. The content is written by invited experts who perform ultrasound in their daily clinical practices and participate in teaching ultrasound nationally and internationally. It conveys the most up-to-date scientific and clinical information in an interactive and visual format. Advanced Thyroid and Parathyroid Ultrasound fills a gap in currently available resources by serving as a single resource unifying information relevant to multiple specialists interested in advanced thyroid and parathyroid ultrasound. It provides a practical, concise yet comprehensive summary of the current status of the field that will help guide patient management.

Chapters

• Milas, K. (2017). Surgical and Ultrasound Topics: 6 chapters for 3 different textbooks. In Controversies in Thyroid Surgery, Advance Thyroid and Parathyroid Ultrasound, Textbook of Complex General Surgical Oncology.

Journals/Publications

• Milas, K. M., Targovnik, J. H., Sidarous, G., Elshimy, G., & Alsayed, M. (2020).

  The Use of 99mTc-Methoxy-isobutyl-isonitrile (sestaMIBI) Uptake on Scintigraphy (99m-STS) in Amiodarone-Induced Thyrotoxicosis: Case Series and Review of the Literature.

  . Case reports in endocrinology, 2020, 2493460. doi:10.1155/2020/2493460
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  Amiodarone is a class III antiarrhythmic drug, used by cardiologists to treat arrhythmia including atrial fibrillation (A fib) and ventricular fibrillation. However, amiodarone is associated with endocrine dysfunction including both hypo- and hyperthyroidism. In the literature, two types of amiodarone-induced thyrotoxicosis (AIT) were described: AIT-1 and AIT-2. Mixed AIT also called AIT type 3 (AIT-3) has been described in the literature when the cases do not have a typical presentation. In order to differentiate different types of AIT, various clinical, biochemical, and radiological tools have been proposed. The use of 99mTc-methoxy-isobutyl-isonitrile (sestaMIBI) uptake on scintigraphy (99m-STS) has been suggested in the literature in only few studies (no large retrospective or prospective studies have been established in the United States). We present a case series describing 5 patients presenting to the University of Arizona with AIT where we used 99m-STS to assess in diagnosis and treatment of different types of AIT followed by a review of the literature.
• Milas, K. M. (2017). Mediastinal Parathyroid Adenoma Resection Through Robotic Video-Assisted Thoracoscopy Utilizing Firefly Fluorescence. VideoEndocrinology. doi:https://doi.org/10.1089/ve.2017.0107
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  To present a case series on biotin interference in parathyroid hormone (PTH) level measurement.
• Haser, G. C., Tuttle, R. M., Su, H. K., Alon, E. E., Bergman, D., Bernet, V., Brett, E., Cobin, R., Dewey, E. H., Doherty, G., Dos Reis, L. L., Harris, J., Klopper, J., Lee, S. L., Levine, R. A., Lepore, S. J., Likhterov, I., Lupo, M. A., Machac, J., , Mechanick, J. I., et al. (2016). ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 22(5), 602-11.
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  The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy.
• Likhterov, I., Tuttle, R. M., Haser, G. C., Su, H. K., Bergman, D., Alon, E. E., Bernet, V., Brett, E., Cobin, R., Dewey, E. H., Doherty, G., Dos Reis, L. L., Klopper, J., Lee, S. L., Lupo, M. A., Machac, J., Mechanick, J. I., Milas, M., Orloff, L., , Randolph, G., et al. (2016). Improving the adoption of thyroid cancer clinical practice guidelines. The Laryngoscope, 126(11), 2640-2645.
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  To present an overview of the barriers to the implementation of clinical practice guidelines (CPGs) in thyroid cancer management and to introduce a computer-based clinical support system.
• Milas, K. M., & O’Glasser, A. Y. (2016).

  Horner’s, Heterochromia, and Harlequins

  . Journal of General Internal Medicine. doi:10.1007/s11606-015-3293-7
• Rajhbeharrysingh, U., El Youssef, J., Leon, E., Lasarev, M. R., Klein, R., Vanek, C., Mattar, S., Berber, E., Siperstein, A., Shindo, M., & Milas, M. (2016). Expanding the net: The re-evaluation of the multidimensional nomogram calculating the upper limit of normal PTH (maxPTH) in the setting of secondary hyperparathyroidism and the development of the MultIdimensional Predictive hyperparaTHyroid model (Mi-PTH). Surgery, 159(1), 226-39.
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  The multidimensional nomogram calculating the upper limit of normal PTH (maxPTH) model identifies a personalized upper limit of normal parathyroid hormone (PTH) and successfully predicts classical primary hyperparathyroidism (PHP). We aimed to assess whether maxPTH can distinguish normocalcemic PHP (NCPHP) from secondary hyperparathyroidism (SHP), including subjects who underwent bariatric surgery (BrS).
• Aliyev, A., Gupta, M., Nasr, C., Hatipoglu, B., Milas, M., Siperstein, A., & Berber, E. (2015). CIRCULATING THYROID-STIMULATING HORMONE RECEPTOR MESSENGER RNA AS A MARKER OF TUMOR AGGRESSIVENESS IN PATIENTS WITH PAPILLARY THYROID MICROCARCINOMA. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 21(7), 777-81.
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  We have previously shown that thyroid-stimulating hormone receptor messenger RNA (TSHR mRNA) is detectable in the peripheral blood of patients with papillary thyroid microcarcinoma (PTmC). The aim of this study was to analyze the utility of TSHR mRNA status as a marker of tumor aggressiveness in patients with PTmC.
• Feng, X., Milas, M., O'Malley, M., LaGuardia, L., Berber, E., Jin, J., Metzger, R., Mitchell, J., Shin, J., Burke, C. A., Kalady, M., Church, J., & Siperstein, A. (2015). Characteristics of benign and malignant thyroid disease in familial adenomatous polyposis patients and recommendations for disease surveillance. Thyroid : official journal of the American Thyroid Association, 25(3), 325-32.
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  Familial adenomatous polyposis (FAP) is a hereditary colon cancer syndrome that involves multiple extracolonic organs, including the thyroid. Several studies have estimated the rate of thyroid cancer in FAP to occur at five times the rate of the general population, but no current consensus defines screening for thyroid cancer in this cohort. This study seeks to define the features of benign and malignant thyroid disease in FAP patients, to compare thyroid cancer cases found through screening with those found incidentally, and to propose disease surveillance recommendations.
• Lairmore, T. C., Diesen, D., Goldfarb, M., Milas, M., Ying, A. K., Sharma, J., McIver, B., Wong, R. J., Randolph, G., & , A. E. (2015). AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: TIMING OF MULTIPLE ENDOCRINE NEOPLASIA THYROIDECTOMY AND EXTENT OF CENTRAL NECK LYMPHADENECTOMY. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 21(7), 839-47.
• Mehra, S., Tuttle, R. M., Milas, M., Orloff, L., Bergman, D., Bernet, V., Brett, E., Cobin, R., Doherty, G., Judson, B. L., Klopper, J., Lee, S., Lupo, M., Machac, J., Mechanick, J. I., Randolph, G., Ross, D. S., Smallridge, R., Terris, D., , Tufano, R., et al. (2015). Database and registry research in thyroid cancer: striving for a new and improved national thyroid cancer database. Thyroid : official journal of the American Thyroid Association, 25(2), 157-68.
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  Health registries have become extremely powerful tools for cancer research. Unfortunately, certain details and the ability to adapt to new information are necessarily limited in current registries, and they cannot address many controversial issues in cancer management. This is of particular concern in differentiated thyroid cancer, which is rapidly increasing in incidence and has many unknowns related to optimal treatment and surveillance recommendations.
• Milas, M. (2015). The genomic medicine paradigm shift. Journal of surgical oncology, 111(1), 1-2.
• Raess, P. W., Habashi, A., El Rassi, E., Milas, M., Sauer, D. A., & Troxell, M. L. (2015). Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease. Endocrine pathology, 26(2), 170-7.
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  Immunoglobulin G4-related disease (IgG4-RD) is an emerging clinicopathologic entity characterized by both IgG4+ plasma cell infiltration and fibrosis in one or more organs, prototypically pancreas or salivary/lacrimal glands. IgG4-RD in the thyroid (IgG4-RTD) is an area of active study, and the relationship between IgG4-RTD and Hashimoto thyroiditis is not fully delineated due to their overlapping histologic features. Retrospective review was performed of all thyroidectomy cases demonstrating lymphocytic inflammation at a single institution over a 4-year period. Approximately half (23/38) of patients had a clinical diagnosis of Hashimoto thyroiditis (HT). Nine of the 38 patients had increased absolute and relative numbers of IgG4+ plasma cells. Patients with a clinical diagnosis of HT had increased lymphoplasmacytic inflammation, but the relative proportion of IgG4+ plasma cells was not increased compared to patients without HT. There was no correlation between IgG4 levels and the amount of fibrosis in patients with or without HT. Patients identified as having the fibrosing variant of HT were not more likely to have increased levels of IgG4+ plasma cells than those without. There is significant morphologic and immunohistochemical overlap between HT and IgG4-RTD. Future studies to identify specific characteristics of IgG4-RTD involving the thyroid are necessary to accurately define this entity.
• Urken, M. L., Milas, M., Randolph, G. W., Tufano, R., Bergman, D., Bernet, V., Brett, E. M., Brierley, J. D., Cobin, R., Doherty, G., Klopper, J., Lee, S., Machac, J., Mechanick, J. I., Orloff, L. A., Ross, D., Smallridge, R. C., Terris, D. J., Clain, J. B., & Tuttle, M. (2015). Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: a multifactorial decision-making guide for the Thyroid Cancer Care Collaborative. Head & neck, 37(4), 605-14.
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  Well-differentiated thyroid cancer (WDTC) recurs in up to 30% of patients. Guidelines from the American Thyroid Association (ATA) and the National Comprehensive Cancer Network (NCCN) provide valuable parameters for the management of recurrent disease, but fail to guide the clinician as to the multitude of factors that should be taken into account. The Thyroid Cancer Care Collaborative (TCCC) is a web-based repository of a patient's clinical information. Ten clinical decision-making modules (CDMMs) process this information and display individualized treatment recommendations.
• Aliyev, S., Agcaoglu, O., Aksoy, E., Birsen, O., Milas, M., Mitchell, J., Siperstein, A., & Berber, E. (2014). An analysis of whether surgeon-performed neck ultrasound can be used as the main localizing study in primary hyperparathyroidism. Surgery, 156(5), 1127-31.
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  Tc-99 sestamibi (MIBI) scan is the imaging study most frequently used in primary hyperparathyroidism (PHP). Transcutaneous cervical ultrasonography (US) is the other modality used for preoperative localization. The aim of this study was to determine whether surgeon-performed neck US can be used as the primary localizing study in PHP.
• Carneiro-Pla, D., Miller, B. S., Wilhelm, S. M., Milas, M., Gauger, P. G., Cohen, M. S., Hughes, D. T., & Solorzano, C. C. (2014). Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: A multi-institutional experience. Surgery, 156(6), 1597-602; discussion 1602-4.
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  Transcutaneous vocal cord ultrasonography (TVCUS) is a noninvasive study used to identify true vocal cord (TVC) mobility. Its sensitivity in predicting TVC paralysis when compared with indirect flexible laryngoscopy (IFL) ranges from 62 to 93%. This study aimed to evaluate the feasibility of surgeon-performed TVCUS in assessing TVC mobility in the outpatient setting.
• Dos Reis, L. L., Tuttle, R. M., Alon, E., Bergman, D. A., Bernet, V., Brett, E. M., Cobin, R., Doherty, G., Harris, J. R., Klopper, J., Lee, S. L., Lupo, M., Milas, M., Machac, J., Mechanick, J. I., Orloff, L., Randolph, G., Ross, D. S., Smallridge, R. C., , Terris, D. J., et al. (2014). What is the gold standard for comprehensive interinstitutional communication of perioperative information for thyroid cancer patients? A comparison of existing electronic health records with the current American Thyroid Association recommendations. Thyroid : official journal of the American Thyroid Association, 24(10), 1466-72.
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  Appropriate management of well-differentiated thyroid cancer requires treating clinicians to have access to critical elements of the patient's presentation, surgical management, postoperative course, and pathologic assessment. Electronic health records (EHRs) provide an effective method for the storage and transmission of patient information, although most commercially available EHRs are not intended to be disease-specific. In addition, there are significant challenges for the sharing of relevant clinical information when providers involved in the care of a patient with thyroid cancer are not connected by a common EHR. In 2012, the American Thyroid Association (ATA) defined the critical elements for optimal interclinician communication in a position paper entitled, "The Essential Elements of Interdisciplinary Communication of Perioperative Information for Patients Undergoing Thyroid Cancer Surgery."
• Kannan, S., Milas, M., Neumann, D., Parikh, R. T., Siperstein, A., & Licata, A. (2014). Parathyroid nuclear scan. A focused review on the technical and biological factors affecting its outcome. Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 11(1), 25-30.
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  Technetium Parathyroid Scintigraphy (TS) is the most popular noninvasive localization procedure in patients with primary hyperparathyroidism (PHPT). Awareness of various factors involved in technetium uptake helps understand the outcome of TS.
• Mehra, S., Tuttle, R. M., Bergman, D., Bernet, V., Brett, E., Cobin, R., Doherty, G., Klopper, J., Lee, S., Machac, J., Milas, M., Mechanick, J. I., Orloff, L., Randolph, G., Ross, D. S., Smallridge, R., Terris, D., Tufano, R., Alon, E., , Clain, J., et al. (2014). Improving the quality of thyroid cancer care: how does the Thyroid Cancer Care Collaborative cross the Institute of Medicine's Quality Chasm?. Thyroid : official journal of the American Thyroid Association, 24(4), 615-24.
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  The current systems of healthcare delivery in the United States suffer from problems that often leave patients with inadequate quality of care. In their report entitled "Crossing the Quality Chasm," the Institute of Medicine (IOM) identified reasons for poor and/or inconsistent quality of healthcare delivery and provided recommendations to improve it. The purpose of this review is to describe features of an innovative web-based program called the Thyroid Cancer Care Collaborative (TCCC) and see how it addresses IOM recommendations to improve the quality of healthcare delivery.
• Metzger, R., & Milas, M. (2014). Inherited cancer syndromes and the thyroid: an update. Current opinion in oncology, 26(1), 51-61.
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  Knowledge related to hereditary thyroid cancer syndromes has expanded enormously. This review identifies contributions that have changed approaches to diagnosis and broadened treatment options for patients with hereditary medullary and nonmedullary thyroid cancers related to multiple endocrine neoplasia type 2 (MEN2), Cowden syndrome, and familial adenomatous polyposis (FAP).
• Milas, M., Deveđija, S., & Trkulja, V. (2014). Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 12(5), 271-89.
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  We aimed to compare single incision laparoscopic cholecystectomy (SILC) to the standard multiport technique (MLC) for clinically relevant outcomes in adults.
• Rajhbeharrysingh, U., Taylor, M., & Milas, M. (2014). Medical therapy for advanced forms of thyroid cancer. The Surgical clinics of North America, 94(3), 541-71.
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  More options than ever before are currently available for medical therapy in patients who present with advanced thyroid cancer or develop surgically unresectable recurrences or symptomatic or progressive disease. The newer medical therapies have addressed the need to find effective therapies beyond the conventional treatment with radioactive iodine, thyroid stimulating hormone suppression, and palliative cytotoxic chemotherapy for patients with advanced thyroid cancer. Although tumor responses to these medical therapies vary by type of thyroid cancer and type of therapy selected, they remain encouraging and provide therapeutic options for selected patients while new drugs are in development.
• Su, H. K., Dos Reis, L. L., Lupo, M. A., Milas, M., Orloff, L. A., Langer, J. E., Brett, E. M., Kazam, E., Lee, S. L., Minkowitz, G., Alpert, E. H., Dewey, E. H., & Urken, M. L. (2014). Striving toward standardization of reporting of ultrasound features of thyroid nodules and lymph nodes: a multidisciplinary consensus statement. Thyroid : official journal of the American Thyroid Association, 24(9), 1341-9.
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  The use of high-resolution ultrasound (US) imaging is a mainstay of the initial evaluation and long-term management of thyroid nodules and thyroid cancer. To fully capitalize on the diagnostic capabilities of a US examination in the context of thyroid disease, many clinicians consider it desirable to establish a universal format and standard of US reporting. The goals of this interdisciplinary consensus statement are twofold. First, to create a standardized set of US features to characterize thyroid nodules and cervical lymph nodes accurately, and second, to create a standardized system for tracking sequential changes in the US examination of thyroid nodules and cervical lymph nodes for the purpose of determining risk of malignancy.
• Agarwal, A., Waghray, A., Gupta, S., Sharma, R., & Milas, M. (2013). Cryopreservation of parathyroid tissue: an illustrated technique using the cleveland clinic protocol. Journal of the American College of Surgeons, 216(1), e1-9.
• Aliyev, S., Taskin, H. E., Agcaoglu, O., Aksoy, E., Milas, M., Siperstein, A., & Berber, E. (2013). Robotic transaxillary total thyroidectomy through a single axillary incision. Surgery, 153(5), 705-10.
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  There is controversy in the literature about whether robotic total thyroidectomy should be performed through unilateral or bilateral axillary incisions. The aim of this study was to perform a detailed critical analysis of the single-incision technique with a focus on postoperative pain, morbidity, and oncologic outcomes.
• Milas, M., Mester, J., Metzger, R., Shin, J., Mitchell, J., Berber, E., Siperstein, A. E., & Eng, C. (2012). Should patients with Cowden syndrome undergo prophylactic thyroidectomy?. Surgery, 152(6), 1201-10.
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  Cowden syndrome (CS) is dominantly inherited and predisposes patients to tumors in multiple organs. We characterized CS-associated malignant and benign thyroid disease.

Presentations

• Milas, K. (2017, October). Giant Graves Goiter. ACS Annual Symposium. San Diego, CA: ACS.

Reviews

• Elshimy, G., Alsayed, M., Targovink, J., Sidarous, J., & Milas, K. M. (2020. Ghada Elshimy, Mahmoud Alsayed, Jerome Targovnik, Gamal Sidarous, and Kresimira M. Milas. The Use of 99mTc-Methoxy-isobutyl-isonitrile (sestaMIBI) Uptake on Scintigraphy (99m-STS) in Amiodarone-Induced Thyrotoxicosis: Case Series and Review of the Literature ,. Hindawi Case Reports in Endocrinology Volume 2020, Article ID 2493460.

Creative Productions

• Milas, K. (2017. Will My Hyperthyroidism Return After Surgerywww.GravesandYou.com.