Tom Hildreth began his wrestling career at Rockwell City High School in Rockwell City, Iowa, wrestling for Coach Bob Anderson.

As a sophomore in 1975, Hildreth qualified for the Iowa high school state wrestling tournament. He was defeated, 6-5, in the medal round and finished just shy of a spot on the award stand.

During his junior year, Hildreth began feeling ill during football season and by the time the district wrestling tournament was being held, he was in St. Mary's Hospital in Rochester, Minnesota, after suffering debilitating paralysis as a result of Guillain-Barré Syndrome. The disease ended his high school wrestling career with a record of 42-13-1, but it would not keep him out of the sport.

Following his recovery from Guillain-Barré and graduation from high school, Hildreth attended Westmar College in Le Mars, Iowa to study science education. He returned to the mat and Milt Martin coached him to a 71-29-2 record, including two individual conference championships and four appearances in the NAIA National Championships.

After graduating from Westmar, Hildreth Pocahontas High School in Pocahontas, Iowa, beginning as an assistant to coach Lynn Moody before taking over as head coach in 1985. Hildreth led the Indians until 1987 when he was afforded the opportunity to return to Rockwell City to coach his alma mater, remaining the head coach through 2003-04.

In 19 years as a head coach, Hildreth had a career dual meet record of 235-66-5 with 36 tournament championships. His teams finished in the top two of the Twin Lakes Conference, including seven tournament championships and six dual championships, in 15 of his 19 seasons. Rockwell City-Lytton placed fourth in the state dual team championship in 1994.

Hildreth coached 45 state qualifiers and had 12 medalists with a champion, a runner-up, a third-place finisher, four fourth-place finishers, two fifth-place finishers, and three sixth-place finishers.

He was named the 2001 Class 1A Northwest Iowa Coach of the Year after his team was unbeaten in regular season dual competition and won every regular season tournament, the sectional tournament, and the district tournament.