Wow! Had a quick look in the .ini but it seemed that my interior shadow settings were already at 4000 so figured, screw it, try the other settings first.
Found a nice location to use as a reference point (looking down the first long corridor in the saphire claw dungeon). With shaodws on ultra the FPS was about 43-45. Decent enough.
Dropped down to medium. FPS became a SOLID 60 FPS. Nothing I could do to cause it to so much as hiccup.
Damn! So I had a look on ''high'' as well. 58-60 FPS. Amazing. I can imagine using high will still cause big drops in certain areas, though, so I think i'll stick with medium. I had a look at both the high and the medium shadow difference and they both look as pixelated as one another, so I see no reason to use any more than medium.
But jeez, what a huge difference, eh? Just goes to show why people are complaining about the shadow system being poor and needing a patch. A 15FPS drop from simply switching from High to Ultra? No thanks.
Yup, I had this exact problem. I was running the game at Ultra settings (no .ini tweaks) @ 1920x1200 on a 2500K + 560Ti system and the FPS outdoors for the most part was around the 60 FPS mark. In some indoor areas it would drop into the 30's but the most annoying part was the major mouse lag associated with this drop in FPS. I also tested in a part specific troublesome spot and figured out that simply changing the Shadow detail from Ultra to High fixed this annoying bug. I also disabled AA, enabled FXAA and tweaked the AF settings via the Nvidia control panel (much more detailed textures/water). I also enabled the self shadowing on Trees/Rocks and increased the Draw distance for Grass. My game now runs at a constant 60 FPS indoors and out so I'm happy

AF Tweaks described here: http://www.geforce.com/Optimize/Guides/five-fast-elder-scrolls-v-skyrim-tweaks-guaranteed-to-make-your-game-look-even-better
.ini Tweaks described here: http://www.overclock.net/t/1166659/the-definitive-skyrim-ini-file-before-and-after-modification-photo-comparison-thread (as mentioned I only used the trees/rocks self shadowing + the grass fade tweaks)
Oh, one more thing. If you do make changes to the settings (in-game or via the launcher) your .ini tweaks will be disabled (as far as I'm aware).
On another note, disabling AA for me was definately worth it as the mem use on my video card dropped from just under 1Gb to around 600mb. My 560Ti only has 1Gb and using FXAA seems to have no real performance impact and is more useful than the standard AA as it also works on textures.