I have a fan shim on mine, and it keeps it well within limits. The shim is controlled by the on die temperature, so it runs slowly most of the time, but if you run the CPU/GPU hard for any length of time, the fan really cranks up. You have to add a driver to have the automatic control.
I had a passive aluminum block heat spreader on it, and that works if you have good thermal bonding, unless you are really working it for a long duration. The problem is, if you hammer it long enough to throttle, that same mass takes a long time to cool back down.
The fan shim on a naked card just seems to work.
https://shop.pimoroni.com/products/fan-shim