I have the same problem. I found out that the slowdown is caused by fog and other transparent particles in dungeons. Since the CPU is rendering this along with shadows, pathfinding & AI, it causes massive FPS drops. Change this setting below to a lower number and you'll see an improvement. Lowering this actually barely makes any difference visually. It just makes fog and particles less dense.
Change this setting in SkyrimPrefs.ini:
[Particles]
iMaxDesired=250
You can go lower than 250 if you want even better FPS.
Thanks - I get a similar effect to the OP, and will try this. Especially if it doesn't noticibly reduce visual quality. I hate the stuttering every time I go underground. Who knew in a huge, open world game with steady 30fps outdoors, seeing dust + candles in a tiny cave would cripple your PC! Overall I can forgive BGS for most mistakes in the game, but this one is ridiculous. Creeping around a dark, dank cavern is not when you want to get all kinds of game-breaking stutter.