Mine had about that many miles when the nut backed off two years ago. I planned to replace the 4500 with a 5600, but I needed the truck driveable right then and needed a low-cost option to buy myself some time.
The local transmission shop did the nut fix for me for about $300. He encouraged me to look for a different transmission since he did not think the nut fix would be very long lasting.
It is still doing fine as I continue to gather parts for my planned and expanding NV5600/NP205 conversion. I'm almost there and now just really need to get through the winter before tackling the dirty part.
Finding a replacement for my t-case has been the biggest holdup. It's tough and expensive to find an older NP241DHD with a speedo sender and I'm alot harder on the 241DLD than I am on 5th gear. I'm really looking forward to getting the NP205 in there as well as the NV5600! Should be close to bulletproof.
I wouldn't worry about rushing into a rebuild or replacement right now if the timing isn't right. A nut job would get you by for awhile if that would help. Maybe you could find a different transmission to rebuild or a better price if you weren't rushed.
You will have the additional expense of a new clutch, pilot bearing, throwout bearing, maybe a rear main seal to consider while the transmission is out. That stuff adds up fast in price. Be ready with everything you need so you don't have to cut corners or repeat your R&R efforts in the near future.
That "temporary" $300 nut job has allowed me to find an NV5600 and flywheel with less than 30k miles on them for $2k, a brand new SouthBend clutch for $500, a $100 NP205, a $140 rebuild kit for it, and the adapter to convert its mechanical speedo drive to an electronic signal for $20. Spreading the cost out keeps me married.
I just need the Advance Adapter kit to bolt the 5600 and 205 to each other, and that costs $414. I've contacted AA to ask them to machine the adapter plate 0. 600" thicker for me so I don't have to trim my NV5600 output shaft 0. 600" like their regular kit requires. I hope they can. The kit is normally used to put an NV4500 into a Ford with a NP205. I can't believe more guys haven't done NP205 conversions in our Dodges instead.
I will still be able to sell my working/repaired NV4500 for about $900 to $1000 when the conversion is done, so I consider the $300 well-spent even on an NV4500 with those miles.