Conditions · Thyroid & Hashimoto’s

Thyroid & Hashimoto’s care that looks deeper

Exhausted, gaining weight, foggy, cold — but told your thyroid is “fine”? A standard TSH rarely tells the whole story. We run the complete picture and build a plan around the root cause. Start with an initial appointment.

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When “normal” labs and how you feel don’t match

Hashimoto’s is the most common cause of an underactive thyroid — an autoimmune process that can drive fatigue, weight gain, brain fog, hair thinning, cold sensitivity, and low mood long before a basic TSH looks abnormal. Too often patients are told everything is fine and sent home.

At True You, Dr. Hoff takes a root-cause approach: comprehensive thyroid and antibody testing, a look at the whole system driving your symptoms, and a personalized, physician-guided plan to help you feel like yourself again.

Why “normal” isn’t the goal

Why your labs look “fine” but you don’t feel it

The difference is what gets tested — and against which range.

The conventional thyroid visit

A single TSH test
“Normal range” = anything not flagged
Antibodies rarely checked
One hormone, one prescription
A 10-minute visit

The True You approach

Full panel: TSH, free T4, free T3, reverse T3
Optimal range — how a healthy thyroid actually reads
TPO + thyroglobulin antibodies to catch Hashimoto’s early
Root causes: gut, nutrients, stress, and conversion
Unhurried time with a physician who monitors over time

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A value can be “in range” yet far from optimal — which is why so many people feel unwell with “normal” thyroid labs.

Signs we hear every week

Tired but wired

Exhausted through the day yet unable to get truly restful sleep.

Weight that won’t move

Doing everything “right” and the scale still won’t budge.

Brain fog & low mood

Cloudy thinking, poor focus, and mood that isn’t like you.

Cold, dry, thinning

Always cold, dry skin, and hair that’s thinning or shedding.

What a True You thyroid work-up includes

Complete thyroid panel

Beyond TSH — free T4, free T3, and reverse T3 to see how your thyroid actually functions.

Hashimoto’s antibodies

TPO and thyroglobulin antibodies to detect the autoimmune driver early.

Root-cause context

Nutrients, gut, stress, and hormones that influence thyroid function.

A physician-guided plan

A personalized plan from Dr. Hoff, monitored and fine-tuned over time.

What is Hashimoto’s disease?

Hashimoto’s thyroiditis is an autoimmune condition: the immune system produces antibodies that target the thyroid gland. Over time, that ongoing inflammation can reduce how much thyroid hormone the gland makes, leading to hypothyroidism. Because thyroid hormone sets the pace for nearly every cell, the effects show up everywhere — energy, weight, mood, digestion, skin, hair, cycles, and how cold you feel.

Hashimoto’s often develops slowly. Antibodies can be elevated for years while TSH still reads “normal,” which is why so many people feel unwell long before they’re diagnosed. It’s also more common in women and tends to run in families.

Go deeper: Hashimoto’s symptoms

Not sure whether your symptoms fit? Start here.

Signs and symptoms of Hashimoto’s

The early physical, energy, and emotional signs that are easy to dismiss — and when to get tested.

Read the symptoms guide

Autoimmune conditions

How we approach the immune side of Hashimoto’s and related conditions.

Learn more

Gut health

Why the gut matters for immune balance and thyroid hormone conversion.

Learn more

Hashimoto’s treatment that goes past the prescription

When the thyroid can’t keep up, thyroid hormone replacement may be part of your plan, and Dr. Hoff prescribes and adjusts it when your labs and symptoms call for it. But medication alone doesn’t address what’s driving the autoimmune process, and many people on thyroid medication still don’t feel right.

So we also look at the factors that influence thyroid function and immune activity: nutrient status such as iron and vitamin D, gut health, blood sugar, chronic stress, sleep, and how well your body converts T4 into active T3. Working on those drivers alongside appropriate medication is what we mean by Hashimoto’s treatment from the root cause.

How it works

How we treat Hashimoto’s

A Hashimoto’s specialist approach, monitored over time.

01

Step 1

Initial appointment

An in-person visit in downtown Fredericksburg to review your symptoms, history, and any past labs.
02

Step 2

Complete testing

TSH, free T4, free T3, reverse T3, thyroid antibodies, and the nutrient and metabolic markers that affect them.
03

Step 3

A personalized plan

Thyroid hormone support when appropriate, plus nutrition, gut, and lifestyle steps aimed at the drivers.
04

Step 4

Monitor and adjust

Repeat labs and regular follow-up — many visits virtual — to fine-tune the plan as you improve.

Who it’s for

Consider a full thyroid work-up if you…

Feel exhausted, foggy, or cold despite “normal” thyroid labs
Have gained weight that won’t respond to diet and exercise
Are noticing hair thinning, dry skin, or constipation
Have a family history of thyroid or autoimmune disease
Are on thyroid medication and still don’t feel like yourself
Are in perimenopause or postpartum and your symptoms have changed

Thyroid & Hashimoto’s — common questions

My thyroid labs were “normal” — why do I still feel this way?

A single TSH is only part of the picture. We test free T4, free T3, reverse T3, and thyroid antibodies, and look at the whole system — so we can find drivers a basic panel misses and build a plan around them.

Do you test for Hashimoto’s specifically?

Yes. We check TPO and thyroglobulin antibodies, which can reveal Hashimoto’s well before a standard thyroid test looks abnormal, so we can act earlier.

Do you take insurance for thyroid care?

True You is a cash-based practice, so your care isn’t limited by insurance rules on which labs or how much time you get. We’re transparent about costs during your consultation.

How do I get started?

Book an appointment. We’ll talk through what you’re experiencing and outline the right next step for your thyroid work-up.

Can Hashimoto’s disease be cured?

There’s no cure for Hashimoto’s, but it can be managed well. Many people feel significantly better when thyroid levels are optimized and the factors driving inflammation are addressed.

Will I need thyroid medication for life?

It depends on how much thyroid function you have and how your levels respond over time. Some people need ongoing medication; others are monitored first. We decide based on your labs and how you feel.

Does diet matter with Hashimoto’s?

It can. Nutrition affects inflammation, gut health, and nutrient status — all of which influence the thyroid. We give personalized guidance rather than a generic elimination list.

Can a thyroid problem affect weight, mood, or menopause symptoms?

Yes. Low thyroid function can stall weight loss, lower mood, and worsen symptoms that overlap with perimenopause. That’s why we test the thyroid as part of any hormone work-up.

Why do I still feel bad on thyroid medication?

Your dose may not be optimized, your body may not be converting T4 to active T3 well, or other drivers — nutrient gaps, gut issues, blood sugar, or hormones — may still be in play. A complete panel helps show which.

Why test reverse T3 and free T3?

Free T3 is the active form of thyroid hormone; reverse T3 is an inactive form. Looking at both alongside TSH and free T4 shows how well your body is actually using thyroid hormone.

Can follow-up visits be virtual?

Many can. Your first visit and lab work are in person at our Fredericksburg office, and much of the ongoing monitoring can be virtual.

Is Hashimoto’s linked to other autoimmune conditions?

It can be. Having one autoimmune condition raises the chance of developing another, so we keep an eye on the broader picture. Learn more on our autoimmune page.

How often should thyroid labs be rechecked?

More often while we’re adjusting your plan, then less often once you’re stable. We set a schedule that fits your situation.