We are developing a microwave tomographic imaging system capable of monitoring thermal distributions based on the temperature dependence of the recovered dielectric properties. The system has been coupled to a high intensity focused ultrasound (HIFU) therapy device which can be mechanically steered under computer control to generate arbitrarily shaped heating zones. Their integration takes advantage of the focusing capability of ultrasound for the therapy delivery and the isolation of the microwave imaging signal from the power deposition source to allow simultaneous treatment monitoring. We present several sets of phantom experiments involving different types of heating patterns that demonstrate the quality of both the spatial and temporal thermal imaging performance. This combined approach is adaptable to multiple anatomical sites and may have the potential to be developed into a viable alternative to current clinical temperature monitoring devices for HIFU, such magnetic resonance (MR) imaging.