As the third pole of the world, the Qinghai-Tibet region plays an extremely important role in the global ecosystem. However, the ecological environment threshold of the Qinghai-Tibet region has long been in a critical state, with fragile natural endowments that are easily disturbed and damaged by human activities. It is urgently needed to strengthen local environmental governance and reduce carbon dioxide emissions. At the same time, the Qinghai-Tibet region has harsh terrain and climate conditions, a sparse population, and relatively low levels of urbanization and industrialization. In this regard, it is imperative to improve the economic level to eliminate relative poverty and improve people's livelihood. However, economic development inevitably consumes fossil energy and produces energy carbon emissions, conflicting with the regional ecological barrier positioning and ecological protection work. Therefore, studying spatial and temporal patterns of energy and carbon emissions and their drivers is critical to decoupling economic growth from energy use and reducing ecological/environmental costs. Using carbon dioxide emission panel data in 2005, 2010, 2015, and 2020 published by China City Greenhouse Gas Working Group, this paper analyzes the spatiotemporal evolution of energy carbon emission sources in the Qinghai-Tibet region and their driving mechanisms. Key findings include: Firstly, the carbon dioxide emissions have expanded 2.37 times over 15 years, growing faster than other regions in China. And this increase poses a serious risk to ecological degradation and pollution. Secondly, the center of carbon dioxide emissions in the Qinghai-Tibet region is mainly located along the northern and eastern edges of the plateau. The spatial pattern remained stable during the study period, but the scale of carbon dioxide emissions in the ecologically fragile areas of southern Qinghai-Tibet gradually increased. Thirdly, the industrial sector is the major source of carbon dioxide emissions in the Qinghai-Tibet region, accounting for as much as 72.4% of emissions. Moreover, the service industry is the fastest-growing sector, and emissions increased by 408.7% over 15 years. Fourthly, the Qinghai-Tibet region exhibits a feature of low development and low energy consumption. Meanwhile, the carbon dioxide emissions from transportation and services are positively correlated with economic growth. Fifthly, the economic impacts on carbon dioxide emissions vary spatially but exhibit a close causal relationship. Finally, considering natural, economic, and environmental interlinkages, pathways for coordinated regional development and emission reductions are discussed. The study aims to enhance macro-level understanding of the characteristics of energy carbon emissions in the Qinghai-Tibet region and provide a scientific basis for research on coordinated pathways between regional economic development and energy carbon reduction, to facilitate sustainable development in the Qinghai-Tibet Plateau region.