Updating on my repair to help future readers:
I got the radiator out and the fan clutch swapped. After cruising on the highway in 80+ degree heat I can confirm the fan clutch was the issue. I never got over ~212 which is the fully opened temp of the thermostat as I understand it. Thank you very much to RetiredWarHorses for your expertise. This made the repair way easier. Thanks to all of you experts helping out around here!!!
The fan didn’t come apart or go together like the TM showed. The 6 bolts that hold the fan to the clutch, and the 4 bolts that holds the clutch to the Geared Fan Drive, are all accessed from underneath the Fan. The tm shows the fan clutch bolting on from the top down, but it actually bolts from underneath the clutch.
After doing it, I’m fairly confident I could have replaced the fan clutch without pulling the radiator. if you remove the top passenger side corner of the radiator shroud, I think that would be enough clearance to reach in and access the necessary bolts. You can see most of them from under the truck as well, looking past the Diff. Give that a try if you ever need to replace yours.