If my tsh w/ reflex to ft4 is 5.05 what needs to be done to lower it?

Thyroid evaluation: You need an overall thyroid gland function evaluation and that will determine the appropriate treatment

Hypothyroidism: Normal TSH is typically 0.45-4.5. Best to discuss results w/ordering physician as some labs have different reference ranges. Regardless, if you have signs & symptoms of hypothyroidism (underactive thyroid = http://www.mayoclinic.org/diseases-conditions/hypothyroidism/basics/definition/con-20021179), prescription levothyroxine will help relieve symptoms but requires close & regular monitoring.