May 16, 2014 12:00 am
Dear Dr. Roach • I am a 63-year-old female of normal weight and active. I exercise several times a week and am in seemingly good health. About a year ago I noticed that my eyebrows were disappearing, starting on the outer edges. They are now almost completely gone. My general physician found that I have thyroid nodules. Three large ones were biopsied and proved negative. Blood work, including a TSH level, is normal. Both my GP and dermatologist feel certain that the nodules are not causing the eyebrow problem, because I don’t have any other symptoms of thyroid disease, but they can’t identify the cause. — K.F.
Answer • The loss of eyebrows, superciliary madarosis, has many possible causes. but low thyroid is the first that most doctors think of. A TSH level is a reasonable screening test for thyroid disease, but if the suspicion is high, I check additional thyroid tests, such a thyroxine (T4), free T4 and T3. Occasionally, TSH still can be in the very broad “normal” range for most people but be abnormal for that person.
Other causes of eyebrow loss include autoimmune disease, inflammatory skin conditions and infection. Repeated plucking of the eyebrows can lead to permanent loss of the follicles. Allergies to cosmetics also can cause eyebrow and eyelash loss. Have you changed your makeup recently?
Dear Dr. Roach • I am a 78-year-old male. I have remained very active, playing tennis twice a week and golf ing twice a week. I have “refractory anemia with ringed sideroblasts,” a type of myelodysplastic syndrome. The treatment program calls for five days of Vidaza injections followed by Neupogen injections if needed.
I have several questions. As I understand it, there is no cure at this time for MDS, so will this treatment be necessary indefinitely? Will Vidaza eventually
become ineffective and some stronger alternative be required? Will this advance to a life-threatening situation without injections? — J.C.
Answer • Myelodysplastic syndromes (that’s “myelo” for “bone marrow,” and “dysplastic” for “abnormal growth”) are diseases of the blood-making cells in the bone marrow. MDS can cause problems in two ways: Most commonly, there is a failure of the bone marrow to make the necessary blood cells (red blood cells, white blood cells or platelets), or by transformation to leukemia.
There are several different subtypes. Some, like refractory anemia with excess blasts, have a poor prognosis, with half of people succumbing to the disease within five to 12 months. Fortunately, refractory anemia with ringed sideroblasts has a better prognosis, with half of people living longer than three to six years.
Azacitidine (Vidaza) is a treatment for MDS. It can improve symptoms and length and quality of life, but it isn’t curative. It is effective in about 50 percent of people with MDS. Filgrastim (Neupogen) is a growth factor for granulocytes, a white blood cell critical for fighting infections.
Most people will continue to progress despite treatment, although at a slower rate. For people who have progressive disease, the optimum treatment isn’t known, and clinical trials are ongoing. I would have to refer you back to your hematologist for what treatment would then be recommended.
The booklet on heartburn explains this common disorder. Readers can obtain a copy by writing: Dr. Roach — No. 501, Box 536475, Orlando, Fla. 32853-6475. Enclose a check or money order for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.
Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital.Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, Fla. 32853-6475