I may not be the best Thresh NA or even a high elo player, I am only Gold V. This however gives me the advantage of seeing how and knowing how Thresh is played in lower elos, which is the type of person who will read this guide. My Lolking Profile and my Lolskill Profile. As both of those show I'm not some thresh god but I can play him at a good enough level for the elo I am currently in. The main goal of this guide is to show lower ranked players looking to start playing Thresh where to go from where they are now and to show new players where to start with a play making support like Thresh.

The runes I use for Thresh are the same runes I use on many supports, in fact I use these runes unless I am playing an AP support. The physical damage marks provide a good amount of harass damage early. The flat armor, mr, and health allow you to be more aggressive in the early game so you can go for first blood at level 2 or simply make going up to harass the enemy ADC less dangerous and more in your favor.

Starting Relic Shield isn't for everyone if you feel that you will miss using charges costing your ADC CS or if you prefer a speed boost grab Ancient Coin instead. Getting 3 Total Biscuit of Rejuvenation and 1 Mana Potion allows you to throw more hooks and use spells more frequently early on which can build lane pressure which can result in a kill or the enemy ADC flashing or losing CS.
Your core items will be face of the mountain, Ruby Sightstone, Turbo Chemtank, Mobility Boots (usually with homeguard), and Randuin's Omen. The final slot can be filled with either Banshee's Veil, Locket of the Iron Solari, or Mikael's Blessing it all depends on what you need at the time. As a final note if you do choose to go with Ancient Coin over Relic Shield get talisman of ascension instead of face of the mountain.

Maxing your Death Sentence first, or your Q, allows you to throw more hooks sooner due to the reduced cooldown which in turn lets you become the best hooker possible. The three early points in Flay are to allow for more trade potential which can make a huge difference in lane. Like anything else abilities can be maxed in a different order. Suppose you're losing lane and need to be able to take more harass than normal, max your Dark Passage, or W, which will allow you take more harass while staying in lane allowing your carry to get more cs without having to leave lane as frequently. Other than that I really do prefer the early points in Flay then maxing Death Sentence, although if I see an opportunity to play more aggressive and throw more hooks I will max my Death Sentence earlier.

Summoner spells are pretty simple, they are on all supports. You need flash to escape or make plays. If you are looking for kill pressure or do not need Exhaust, they do not have an assassin like Zed, take Ignite for the lane pressure and increased first blood potential. If they do have an assassin always take Exhaust to keep them from blowing the carry up. Also in bottom lane fights don't Exhaust right at the start wait for the other carry and support to commit to the fight and as soon as they do Exhaust the enemy adc so that you will have the advantage in the fight.

Support matchups

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I don't feel that there are many supports that are just a flat out loss for Thresh, I will however rank them from 1-10, 1 being terrible and 10 being a free win.

---- Morgana I put this at a 3 it is a pretty bad lane due to Black Shield but you can learn to play around it and still make plays regardless. There is no cut and dry way of saying what exactly to do but for the most part use Flay to get Black Shield out or try using Death Sentence in a way that hooks the target that seems the least likely to be hooked at that time, if that makes sense.

---- Blitzcrank This is one I put at about a 5 it is by no means a losing lane even though Blitzcrank tends to have a high win rate. Try to use Death Sentence after Rocket Grab has been used, preferably missed. Just play around his Rocket Grab and avoid standing in the open when you have them pushed back.

---- Nautilus For this matchup you want to play fairly similar to how you play Blitzcrank but I feel this lane is slightly easier so I give it a 7. Just because I gave it a 7 does not mean it is an easy win. I feel that Thresh brings much more utility and can do more for a team later in the game. However you can not underestimate Nautilus because of how tanky he is and how quickly he can snowball a lane. If played properly, by playing around Nautilus and avoiding all ins, this lane can be won fairly easily. There will not be much kill potential but that just means you use range to harass and build a cs lead that will win lane that way.

---- Leona Get between her and your adc when she tries to engage and Flay her back other than that just don't play stupid it then becomes a fairly easy lane.

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ADC matchups

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This will be kept simple there will only be two categories.

---- ADCs with escapes such as: Lucian, Graves, Ezreal, [kalista]] with her passive, and even Vayne now that tumble has been fixed. The best way to beat Thresh is to pick an adc with escape and avoid hooks with it so if you pick Thresh before the enemy adc be ready to miss more hooks. All you can really do is try to bait out the escape and then use Death Sentence.

---- ADCs without an escape so this is a much easier matchup where when you throw a good Death Sentence that could lead to a kill all they can do is Flash to escape or die and if they have Flash they will use it, that just means next time it will be a kill.

Thresh is a very aggressive playmaking support so if that's what you're looking for I hope this guide helped if not go play Janna you wussy. All in all Thresh takes lots of practice and know how so don't expect to be great your first game or your first several games it takes time.