The card runs fine out of the box, and is very quiet (40db), even after 2 hours playing Tomb Raider at 100% core load with no throttling.
But the radiator has to be positioned as per instructions
a) Needs cold air
b) Has to be higher than the card
c) The pipes have to be at the bottom.
So some of us, are lowering the voltage to lower the unneeded heat, without affecting the card performance (hell even takes a huge overclock with less power), replacing the fans to mitigate the cold air that we cannot get inside the case etc.
And a final thought. This is "Overclockers". Anyone around here complaining about fiddling with the card, is on the wrong forum