Hereditary transthyretin (TTR) amyloidosis, traditionally referred to as familial amyloid polyneuropathy, is an autosomal dominant multisystemic disease caused by the extracellular accumulation of abnormally misfolded TTR developing multiorgan failure. Autonomic manifestations are frequently reported in these patients. Among these, orthostatic symptoms resulting from cardiovascular autonomic dysfunctions significantly disturb daily life. Usual manifestations include symptoms of peripheral neuropathy, which may evolve into severe manifestations of generalized autonomic dysfunction, in addition to cardiological, neurological (peripheral sensory-motor polyneuropathy), visual, genitourinary, renal, and gastrointestinal symptoms. Early detection is extremely important, aiming for treatment and preventing progression.