Still really early, but it's not quite as bad as I thought it would be. I'm getting around 45-55 in most places around Sanctuary Hills. Mostly High, with one or two Ultras (the ones that don't cause much performance hit), Godrays on Low. They actually don't look that bad even on the lowest setting. That's at 1440p with a GTX-680.
Performance is far from steady, though, I think that's the biggest problem it has. Just walking down a simple hallway in the Vault, the framerate would fluctuate wildly from 40 up to 60+, then back down to 30 or so. That unevenness seems to be causing most of what I see as stuttering, where the framerate suddenly plummets when I face a particular direction, even though there's nothing visibly on screen that would make it do that.
I've got the framerate unlocked just to make sure that Gsync is doing its thing, and it appears to be, as there's certainly no tearing, and I'm occasionally going over 60fps. I haven't done anything else in the .ini files except mouse acceleration and movement.
How bad is the hit from pushing Shadow Distance to Ultra? I did notice once I got outside that I'm seeing shadows fill in ahead of me, which I figured High would mostly alleviate, but I don't really want to kill my framerate if it's too big a hit. Kind of wish the tweak guide was up, I had made a bunch of notes yesterday, and now I want to go back and go through it again now that I've had a chance to play it.