This study analysed satellite images and long term climate variables from a high-elevation meteorological station (4730 m) and streamflow records to examine hydrological response of Nam Co Lake (4718 m), the largest lake on the Tibetan Plateau, over the last 50 years. The results show the lake area extended by 51.8 km2 (2.7% of the total area) when compared with the area in 1976. This change is associated with an annual precipitation increase of 65 mm (18.6%), annual and winter mean temperature increases of 0.9 °C and 2.1 °C respectively, an annual runoff increase of 20% and an annual pan evaporation decrease of about 2%, during the past 20 years. The year of the change point in annual precipitation, air temperature, annual pan evaporation and runoff occurred in 1971, 1983, 1997 and 1997, respectively. The timing of the lake growth corresponds with the abrupt increase in annual precipitation and runoff since the mid-1990s.