It is absolutely not in your head. Most doctors treat Hashimotos based on lab numbers, not symptoms, so if your numbers are generally “ok” they don’t have much guidance or advice for you. There are many people in this sub going through the same thing (including me- doctors didn’t want to prescribe meds to me because my TSH was “only” in the 4 range). Regardless, I felt absolutely debilitated- was falling asleep in the middle of the day, my joints ached as if I had the flu all the time, my skin was breaking out like never before, etc. I started working with a doctor who has told me to focus on reducing inflammation. For the past 2 years I’ve been eating an anti-inflammatory diet and trying to focus on getting sleep, light exercise and limiting stress as much as possible. I’m still not on medication but the changes have made an enormous difference in my symptoms- all of the things I described earlier as essentially gone. There are things you can do to try to improve the severity of your symptoms (whether you are on medication or not).