Cleveland Clinic Establishes New Thyroid Center

About the Physician

Dr. Kresimira (Mira) Milas is Director of the Thyroid Center, Associate Professor of Surgery at the Cleveland Clinic Lerner College of Medicine and a staff surgeon in the Cleveland Clinic Department of Endocrine Surgery. Her specialty interests include the entire spectrum of thyroid and parathyroid diseases and surgery, thyroid cancer, and adrenal diseases.

As a result of my background in both endocrine surgery and surgical oncology, the primary focus of my professional activities is the field of endocrine tumors. This encompasses predominantly diseases of the thyroid, parathyroid and adrenal glands. The values guiding this professional activity are the paramount importance of excellent and compassionate patient care, dedication to resident and medical student teaching, and innovative clinical investigation. Two major areas of clinical research are the focus of my current activities: the biology of multigland parathyroid hyperplasia, and novel molecular markers for thyroid cancer. By detecting circulating thyroid cancer cells, TSHR mRNA has become the first new molecularly-based bloodtest to be added to the armamentarium of useful thyroid cancer markers.

It is my commitment to provide uncompromisingly great care to patients with endocrine surgical diseases. My passion is to advance our understanding of thyroid cancer and parathyroid disorders. It is rewarding to witness the labor of my translational research efforts, in collaboration with colleagues in Pathology, leading to the routine use of TSHR mRNA in daily clinical practice and as a reference lab available nationally and internationally via the Cleveland Clinic. I am also a strong advocate of surgeon-performed ultrasound and have a dedicated program in ultrasound education for surgical residents, as well as surgeons and endocrinologists nationally. Multidisciplinary collaboration and the building and leadership of such programs have been a daily endeavor. It is a privilege to serve as Chair of the Clinical Affairs Committee for the American Thyroid Association for 2009. With enthusiasm, I envision a long and productive surgical career that contributes new knowledge and treatment options, leads to recognition in the field of endocrine surgery for lasting improvements in the well-being of endocrine patients, and inspires future residents and students to consider a similarly wonderful career path.

- Kresimira Milas, MD

A new multidisciplinary Thyroid Center has been created within Cleveland Clinic’s Endocrinology & Metabolism Institute to streamline care for patients with all types of thyroid disorders, including thyroid cancer, thyroid nodules, hyper- and hypothyroidism conditions such as Graves’ and Hashimoto’s diseases, medication-induced thyroid disorders, and hereditary neoplasias.

Established in November 2008, the Thyroid Center brings together endocrine surgeons, endocrinologists and their nursing staff under one roof to provide comprehensive and collaborative care, explains Mira Milas, MD, endocrine surgeon and director of the new center.

“The reorganization of Cleveland Clinic into an institute model, focused on organ and disease systems rather than physician specialties, has really allowed this multidisciplinary center to happen,” Dr. Milas says. “This is a center designed to provide the best care to patients with thyroid problems by ready access to many dedicated specialists and ongoing innovations. Our goal is to reach out to both patients and their referring physicians and bring new benefits to the care of thyroid conditions – from routine problems to the most complex.”

The Thyroid Center, which is co-directed by endocrinologists Mario Skugor, MD, and Christian Nasr, MD, eliminates the need for patients to travel to four or five separate locations for various medical appointments and testing. Patients with thyroid disorders are now triaged to improve both efficiency and the patient experience. The expertise of collaborators from a number of fields – pathology, radiology, genomic medicine, oncology, and other surgical specialties – is integral to the center.

Dr. Milas says establishment of the center is timely because thyroid cancer has the most rapidly rising incidence rate of any cancer to affect women, and also has rising mortality rates for cancers among men. Nationwide, the advantages of medical care in specialized, high-volume centers are increasingly being contemplated. Recent research highlights benefits for patients treated at high volume centers for thyroid and parathyroid surgery, in terms of fewer complications and improved outcomes.¹

The Thyroid Center will now be home to the largest thyroid cancer surgical program in Ohio and the five surrounding states, having high patient volumes that include about 500 endocrine neck surgical procedures every year – many of which are for complex and reoperative surgeries.

The new center is dedicated to bringing new knowledge and advantages to both patients and
physicians. It is one of only few centers nationwide to provide radiofrequency ablation of liver metastases from thyroid cancer and have robotic surgery expertise. It also has nationally and internationally recognized expertise in thyroid ultrasound, and novel diagnostic markers and genetic evaluations of thyroid cancer patients.

The Thyroid Center, which will move into a new home in September, hopes to enhance current programs in clinical, translational and outcomes research, as well as provide access to clinical trials for patients with thyroid cancer, Dr. Milas adds.

¹ Mitchell J et al . Avoidable reoperations for thyroid and parathyroid surgery: effect of hospital volume. Surgery. 2008 Dec;144(6):899-906; discussion 906-7.

Stavrakis, AI et al. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery. 2007 v. 142 p. 887–899.

Pieracci FM, Fahey TJ 3rd. Effect of hospital volume of thyroidectomies on outcomes following substernal thyroidectomy. World J Surg. 2008 May;32(5):740-6.

History of Thyroid Disease at Cleveland Clinic

Our new Thyroid Center builds upon Cleveland Clinic’s history of innovation in thyroid care, which dates back to George Crile, Sr., MD, a founding member of Cleveland Clinic who was a pioneer in the area of thyroid surgery. With meticulous surgical technique, he was able to improve the safety of thyroid surgery, a previously high-risk procedure, and to develop the modified radical neck dissection, giving Cleveland Clinic international recognition as a center for patient referral. Dr. Crile performed more than 35,000 thyroidectomies and this was part of the early fame and success of Cleveland Clinic.

This legacy was continued by his son, George Crile, Jr., MD, who established a standard operation for patients with thyroid cancer, as well as breast cancer, by demonstrating that less radical and less disfiguring procedures gave excellent results. Caldwell Esselstyn, MD, subsequently set the standard for more than 30 years as a leader in endocrine surgery, with a nationally and internationally respected reputation in the areas of parathyroid and thyroid surgery.

Currently, the program in thyroid disorders has experienced ongoing growth in clinical, research, and education endeavors. Cleveland Clinic is ranked among the top 10 best centers for endocrine disease treatment in the country by U.S.News & World Report.

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