This review demonstrates that gut microbiota dysbiosis plays a pivotal role in hyperuricemia and gout pathogenesis through three interconnected mechanisms: dysregulated uric acid metabolism via altered microbial enzymes and transporter expression, disrupted intestinal barrier integrity across physical, immune, and chemical barriers, and aberrant immune activation characterized by TLR4/NF-κB priming, NLRP3 inflammasome assembly, and IL-1β-mediated inflammatory cascades. Here, TLR4 is linked to gout.