This study proposes a novel computationally efficient methodology to perform topology optimization (TO) of fourth-order plate structures within the framework of multi-patch isogeometric analysis. This is realized by taking the multifold benefits of isogeometric PHT-Splines to (1) discretize the C1 continuous weak form of plate structures, (2) develop a C0 continuous density field for the material distribution in TO and inherently remove the need for filters, and (3) provide a hierarchical tree structure for the structural mesh to effortlessly implement an adaptive mesh refinement (AMR) strategy. Moreover, to ensure continuity between isogeometric patches, we adopt a strong C1 coupling between the boundaries. This is established by constructing new basis functions, defined as a linear combination of existing C0 functions at the patch interfaces. The density field in TO is further enhanced with a first-neighbourhood smoothening algorithm based on the Shepard function to generate printable topologies and alleviate the post-processing stages after optimization. An element-centre density, based on the control point densities of the isogeometric mesh, is used as the marking scheme for the AMR to determine the subdomains to be refined. Utilizing the Geometry Independent Field approximaTion, the design and adaptive analysis-optimization stages were independently discretized respectively through NURBS and PHT-Splines, allowing easy transfer of multi-patch geometries from industry-standard packages. Multiple numerical examples illustrate the stability of the multi-patch algorithm in optimizing the geometries effectively. The results also show considerable advantages in terms of solution accuracy such as precise field, smooth topology and computational efficiency. •Isogeometric topology optimization (ITO) for fourth-order plate structures.•Continuous material distribution to ensure smooth topology.•Boundary-tracking AMR strategy for computational efficiency.•Robust C1 coupling for seamless solution continuity across patches.•Integrating AMR into C1 coupling for ITO of multi-patch plate structures.