I have a blood test done and my tsh reflex to free t4 is 4.53 .50-4.30 miu/l is that bad?

Mildly abnormal: That TSH is mildly high, implying that you may have mild hypothyroidism. The free T4 is likely to be in the lower range of normal. Most people with these numbers will have no symptoms at all. If you have hypothyroid symptoms and evidence for chronic thyroid disease, it would be reasonable to take thyroid hormone. Otherwise, you should have repeat levels in a few months.

I agree to a point!: Tsh slightly elevated. Your body thinks your thyroid is low. The most common cause for hypothyroidism is hashimoto's thyroiditis, which can be indentified by the presence of anti-thyroglobulin antibodies and anti-TPO antibodies. Have these tests. If positive, i would place you on thyroid immediately. I would also have my free-t3 checked as well. Some do not convert T4 to t3!