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Ekko is probably the worst thing you can ever come across with mid lane Thresh. He literally evades all of your combo by clicking R, without taking into consideration the fact that it's almost impossible to hook him. If you have the chance, just ban him or switch lanes for a more favorable match up.
Cassiopeia
I personally don't have a lot of trouble against this matchup, but if played by a competent player, she can give you a world of troubles with her neverending harass and DoT. Keep in mind that if you manage to Q+E+Ignite her it's a secure kill.
Zed
This guy is quite helpless against you; if he chooses to harass you with his shadow, then he loses his escape for a good time which opens you chances for a clean combo. Rush Zhonya's Hourglass against him and you'll be fine.
Fizz
Fizz has got quite the upper hand when against you; he can bait your Q easily by Eing away and if he chooses to engage with his ult, you don't have many tools to protect yourself. Play it safe and call help from your jungler when you see a chance.
Teemo
When against the Devil itself, you either have to praise the sky for some divine help or, more simply, ask your jungler to pressure him. I think he's an hard matchup because with his W and his Q he can harass you pretty safely without worrying too much about hooks. When he hits 6, he can also plant mushrooms everywhere to slow down your roaming potential and maybe sneak up a kill on you. Tips: play safe and ask your jungler to bother him, so he doesn't get too confident.
Heimerdinger
Not much to say here, almost nobody can win lane against Heimerdinger, so it's quite about farming and playing it safe. However if he should misposition himself and open a chance for your Q, make sure to not drop right into his turret field. Not an hard matchup overall.
Annie
Annie, by having an abnourmous close range burst, threatens Thresh quite a bit, since if you manage to hook her, she will E in your face and pop up all her skills on you. You might try to sneak a kill before she gets her ultimate, past that it becomes really risky. Try to ask your jungler to gank her, if you play it properly you can kill her.
Katarina
Seemingly easy matchup, she doesn't have many tools to kill you, her ult is easily stopped with your E and if you manage to hook her, she will have to Shunpo away, so engaging when her E is on cooldown is a smart choice. Not problematic at all.
Twisted Fate
Another rather easy matchup, all he can do if you grab him it's popping his Gold Card and try to escape by stunning you. However watch out for his Q and autos harass, if he stays behind minions it won't be hard for him to cut a good chunk of HP from you. Be sure to call MIA whenever you don't see him. Not particularly dangerous.
Malzahar
Malzahar, with the new passive update, has got a free Spell Shield that will give him the chance to take a free hook without any problem. What you must aim to do as Thresh, is to pop his passive with your autos and then you might have a chance. I wouldn't tip to go all in on this guy unless you are sure to catch the kill.
Morgana
Well, she is Thresh's public enemy n°1. She has EVERYTHING that she needs against you. Long range AOE harass, spell shield to avoid hooks shutting down your offensive capability and a Q that she won't have an hard time aiming because of your low movement speed. By all means, you should NEVER go all in on her: just sit back and farm and start roaming until you hit six. It's almost impossible to win this lane.
Ahri
She is not exactly the matchup you want to have: lots of mobility, safe harass and most importantly a deadly combo that can 100-0 you if not being careful enough. If you manage to hook her however, she might find herself obligated to use her ultimate, burning most of her burst this way. Don't go reckless on her and engage when her E and R are on cooldown.
Yasuo
Yasuo is a weird matchup: he doesn't have any reliable escapes, but he's got a good harass with his stacked Q and he can close the gaps easily, preventing you from farming. Pop his passive when it's fully charged and play carefully. If you manage to bring him under tower somehow, he is almost surely going to die because of his lack of escape.
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