Carpal tunnel syndrome (CTS) is well recognized as the most common type of peripheral neuropathy. Encountered causes of carpal tunnel syndrome are rheumatoid arthritis, diabetes mellitus, and trauma. A rare cause of CTS is tophaceous gout. Tophi deposits can accumulate in various structures including the flexor tendons, tendon sheaths, transverse carpal ligament, and even the median nerve, causing various symptoms such as pain, numbness, and weakness. Tophi forming in the carpal canal can compress the median nerve, leading to CTS. Here, it is described a case of a 56- year-old male without a known family history of tophaceous gout who presented with typical CTS symptoms. CTS symptoms were eased through surgical removal of tophi and decompression of the median nerve. This case shows that CTS symptoms could be the initial manifestation of tophaceous gout. Surgical removal of gout tophi and decompression of the median nerve is an effective option for eliminating symptoms