Introduction: Obesity is a complex metabolic condition associated with significant cardiometabolic risks. The Comprehensive Metabolic Therapy (CoMeT) programme is a multidisciplinary intervention designed to address these risks through integrated medical management, physiotherapy, and dietary counseling. This pilot study aimed to evaluate the effectiveness of the CoMeT programme on anthropometric, metabolic, and body composition parameters in adults with obesity. Methodology: We conducted a pilot pre–post study involving 11 adults with obesity (BMI ≥27.5 kg/m²) enrolled in the CoMeT programme at Hospital Putrajaya. Assessments at baseline and post-intervention included anthropometric measures (weight, BMI, waist circumference), metabolic parameters (hemoglobin A1c [HbA1c]), and body composition (skeletal muscle mass [SMM], body fat percentage) using InBody 970 bioelectrical impedance analysis. Data were analyzed using SPSS version 29.0. Results: The mean age was 38.5 ± 8.9 years, with baseline weight 134.7 ± 20.9 kg and BMI 49.8 ± 9.0 kg/m². Three participants defaulted follow-up, leaving eight for post-intervention analysis. The mean weight reduction was 2.1 ± 6.4 kg (1.6 ± 5.0%). Notably, the greatest reduction (−12.5%) occurred in a participant with high adherence to both the dietary and physiotherapy components of the intervention. Participants receiving GLP-1 receptor agonists (oral semaglutide) also demonstrated weight reduction (mean −2.5 kg). Conversely, weight gain was observed in some participants despite diet modifications, potentially due to low physiotherapy attendance or baseline metabolic factors. HbA1c improved modestly (−0.19 ± 0.29%). Body composition changes were minimal, with slight reductions in body fat percentage (−0.13 ± 1.2%) and SMM (−0.49 ± 1.88 kg). Conclusion The CoMeT programme shows promising early-stage effectiveness in improving anthropometric and metabolic outcomes with the greatest benefits observed in patients achieving high multidisciplinary adherence and adjunct pharmacotherapy. These findings highlight the potential of a multidisciplinary approach in managing high-grade obesity and emphasize the need for larger-scale studies to further validate these outcomes and optimize targeted lifestyle and therapeutic interventions
Body Composition ; Adult ; Obesity

Introduction: Primary thyroid lymphoma (PTL) is a rare malignancy representing 1–5% of all thyroid cancers, most frequently arising on a background of chronic autoimmune thyroiditis. Case: We report a 73-year-old Malay male who initially presented with large goiter, symptomatic bradycardia, and subsequently developed severe primary hypothyroidism (thyroid-stimulating hormone 231 mIU/L, anti-thyroid peroxidase 643 IU/mL), consistent with Hashimoto’s thyroiditis. During his clinical course, he also sustained a non-ST elevation Myocardial Infarction which was attributed to demand-supply mismatch of hypothyroidism. Computed tomography scan of the neck revealed a large multinodular goiter with retrosternal extension, tracheal compression, and extensive nodal lymphadenopathy. Initial Fine needle biopsy was non-diagnostic, but a repeat biopsy was performed due to rapidly enlarging goiter within weeks with suspicious nodules seen on bedside thyroid ultrasound. Ultrasound-guided core biopsy confirmed Diffuse Large B-cell Lymphoma (DLBCL), non-germinal centre B-cell (non-GCB) subtype. Despite initiation of levothyroxine and corticosteroid therapy, the patient deteriorated with remarkable rapidity over the ensuing weeks, culminating in a 15 × 10 cm compressive neck mass, Type 1 respiratory failure, hypercalcemia, complete dysphagia, and concurrent pneumonia. He was then transferred to hematology tertiary centre for commencement of his chemotherapy. Conclusion This case of PTL presenting in the background of Hashimoto’s thyroiditis emphasizes the role of early tissue diagnosis in patients with rapidly enlarging goiter. Identification of PTL is critical because management shifts from surgical intervention to systemic chemotherapy.
Thyroiditis