Highlights from the article: Patients with hATTR often present with small fibre symptoms, but these are not specific, and a definitive diagnosis is not made until further hATTR manifestations emerge [[1]]. Significant cutaneous denervation has been demonstrated in patients with overt neuropathy [[3]], and TTR mutations when compared with controls, and intermediate reductions in non-symptomatic patients [[4]]. Under the earliest classification of symptoms in hATTR evaluations, patients had consistent abnormalities among all of the small nerve fibre evaluations performed.