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Also, run the game from an SSD if you have one.
[General]
iFPSClamp=58
According to the Bethesda.net forum is 58 a magic value, which avoids issues with a few terminals in the game or else the player could otherwise get stuck at them.
When you had success with adaptive VSync then try to combine it with this .ini parameter. You'll probably have to put it into Fallout4Custom.ini and Fallout4Prefs.ini. Note that it doesn't go into the [Display] section.
But if you get yourself Bilago's Configuration Tool then you can use it to set the parameter and it knows where it needs to go. I've stopped editing the .ini files a while ago and only use this tool for tweaking the .ini files. It makes this so much easier and faster, and can replace the game launcher, too, has got extra tabs for the most common .ini parameters and more. If you get yourself the tool then I won't need to search for where exactly the parameter goes into!
http://www.nexusmods.com/fallout4/mods/102/?
Or just try sticking the value in all three .ini files and create a [General] section if there isn't any (but first check if there really isn't such a section).
Try making the following edits to your enblocal.ini file:
[MEMORY]
ForceVideoMemorySize=true <--- this should reduce or eliminate the stutter (worked for me)
VideoMemorySizeMb=10240 <--- should be fine for your rig.
Hope this makes a difference. If not, here's a link that might help you further:
http://forums.bethsoft.com/topic/1543988-a-data-vault-of-tweaks-and-fixes-for-the-pc-version/
Also, when you can lower the monitor to 60HZ then you should be able to use adaptive VSync. If it then cuts it down to 30 fps then you probably have it enabled twice or set to half-adaptive.
When you've tried a lot of different things then it might be worth it to double check everything.