EDIT:
After today’s stream, I agree with Rod that everyone having problems should include their dxdiag’s, so I added mine as well.
msinfo32 (to big for pastebin): https://pastes.io/h7zzjmi2x3
dxdiag
ORIGINAL POST:
The only real solution right now is to lower the texture quality until the usage of VRAM is below the max VRAM available. You can see your VRAM usage usage with multiple programs, one of the most popular being MSI Afterburner. The stutters (at least for me) are happening because I’m out of VRAM and the game has to swap assets from RAM / SSD.
Blizzard please do something and make the assets swap from RAM to VRAM smooth.
There are other large open world games that swap assets from RAM to VRAM without any stuttering.
I got a 3080 Ti, the game runs great at 140+ fps, with everything on ultra (including textures), but because of the stutters, I have to play with the textures on medium so the game don’t need to swap assets, and it looks like crap.
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Thats not the only real Solution.
First , go to Battelnet Client Settings and activate the client to be closed when starting a Game. That helps against the stuttering.
In order to tune the FPS lower the texture quality is the Last thing you should try, even on High the game looks waaay worse ( on medium it starts to looks like a Switch Port).
If your Graphics Card supports DLSS i would start with that ( even on performance it looks waay better than without DLSS and lower texture quality)
I m able to play the Game in 4K (texture quality Ultra) with a i7 8700K ( oc to 4.4 ) and a Asus Geforce 2070 OC 8GB with 60 FPS ( 60 FPS limit and Vsync in the Nvidia Control panel not the game itself ) DLSS on balanced. Only after TP to a Big Settlement it drops to 35-40 Fps for about 5-10 sec.
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at what temperature is your GPU running while playing Diablo 4 4K?
i have a rtx 2080 super but i’m not sure if my GPU can handle 4k on a normal temperature
You might want to check your network latency in game (CTRL+R twice). I had high fps but the game was still somehow freezing. If you use WIFI or a docking station, I suggest you try to plug an ethernet cable directly to your computer.
I didnt check so far, i will tell you after Blizz was able to fix their Login ( i was actually nearly done with the main Storyline while that happend :-/).
I was playing a Necro on lvl 52 with +2 Meele and +2 Ranged Skelettons and a Golem + the NPCs in Act 6 and the FPS has been stable at 59-60 the whole Time ( reached the End of “The Blind Eye” before the Server kicked me out).
But I never had any Thermal issues with my System , using a Be Quiet Dark Base 900 Tower with open Front Door and fans on max while running Games that max out my GPU. Last Game i played was Assassins Creed Valhalla with my GPU at 98% constantly without any problems and i played that Game for nearly 150 hours.
CPUID HWMonitor:
Max 83 °C (181,4 °F)
Hot Spot 94 °C (201,2 °F)
thanks for letting me know 
Try disabling vsync and Turning it back on or leaving it off. Also cap your Framerate at 59. Worked for me but I am no expert.
I can attest, the Battlenet launcher was a big improvement, but I’m still getting the stuttering. I’ve swung the sliders all back and forth and none of it seems to make a difference.
Yeah, i’m playing at 4k and it runs smooth at ultra settings across the board until vram hits limit and giant stutters begin and I have to lower to high textures, then back to ultra. I’ve got a beast computer that meets the 32 gigs of fast sysram and 16 gig vram requirements so it’s just a game issue. Sucks because the high textures look like doodoo compared to ultra.
I had the same Problem and the battelnet Client itself caused it.
You can try to enable the option that the Client close itself when you start a Game, that fixed it for me.
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Fuark it worked, I read it and thought that it won’t do anything, but whaddya know it actually solved it, thanks man!! Crazy that the client being open causes that big of an issue
I haven’t noticed stutters on my old 1080ti, but I did get the invisible wall a few times in the city. I logged out and back in to fix it.
those old skinny chips don’t have the firepower necessary to compete with the big green nvidia monsters of today
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After today’s stream, I agree with Rod that everyone having problems should include their dxdiag’s, so I added mine as well.
the 1080ti is still a terrific 1080p card. Just as good as a 3060ti and a 2070