High-altitude environments characterized by low air pressure, hypoxia, and strong solar radiation have a significant impact on human thermal comfort; however, existing thermal comfort theories and evaluation models are primarily developed under low-altitude climatic conditions, and their applicability in plateau regions remains limited. With the acceleration of urbanization and the increase in residential, tourism, and occupational activities in high-altitude areas, systematically reviewing the research progress on thermal comfort in such environments is of great practical significance. This study combines systematic literature retrieval and bibliometric analysis, based on the Web of Science Core Collection and China National Knowledge Infrastructure (CNKI) databases, to analyze relevant studies published since 2001. Using CiteSpace, research hotspots, collaboration networks, and evolutionary trends are visualized. The results indicate that current research hotspots mainly focus on physiological responses and thermal adaptation mechanisms under low-pressure and hypoxic conditions, thermal comfort regulation strategies for high-altitude buildings and environments, and the applicability and modification of conventional thermal comfort models. Emerging trends include multi-environmental factor coupling analysis, adaptive model development, region-specific building design approaches, and health-oriented comprehensive evaluation frameworks. The findings provide valuable references for building thermal environment design, regional revision of thermal comfort evaluation standards, and policy-making in high-altitude regions.