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On March 12, 2020, Thompkins tested positive for SARS-CoV-2, the virus responsible for the COVID-19 pandemic. He was the first professional basketball player in Europe to be diagnosed with the virus.

In May 2018, Real Madrid won the 2017–18 EuroLeague championship, after defeating Fenerbahçe Doğuş in the final game with 85–80. Over 28 EuroLeague games, Thompkins averaged 9.5 points, 5.1 rebounds and 1.1 assists per game.

On July 6, 2018, Thompkins re-signed a two-year deal with the Spanish team Real Madrid.

On August 26, 2015, Thompkins signed a one-year deal with the Spanish team Real Madrid. On July 16, 2016, Thompkins signed a two-year contract extension with Real Madrid.

On August 4, 2014, Thompkins signed a one-year deal with the Russian team Nizhny Novgorod. From the start of the 2014–15 season, he saw a lot of trust from the team's head coach, Ainars Bagatskis, as he played at least 20 minutes per game, in both the VTB United League and the EuroLeague. On November 6, in a home game loss to Anadolu Efes, he had 14 points and 10 rebounds, making his first EuroLeague double-double. On November 21, against Dinamo Sassari, he grabbed a season-high 15 rebounds, also scoring 13 points. Nizhny Novgorod finished 4th in its EuroLeague group, and advanced to the EuroLeague Top 16.

Thompkins was drafted with the 37th overall pick in the 2nd round of the 2011 NBA draft by the Los Angeles Clippers. In his first season with the Clippers, he averaged 2.4 points and 1 rebound over 24 games played. In the summer of 2012, during the NBA Summer League, he suffered a bone bruise on his left knee, which sidelined him off the court for nearly two years, including the rehabilitation time. He was waived by the Clippers on March 14, 2013.

On February 6, in a game against Unicaja, he scored a season-high 27 points, and added 13 rebounds, to help his team win the first game in the EuroLeague Top 16. That was also his third straight EuroLeague game win which he scored more than 20 points. Nizhny Novgorod eventually finished its participation in the EuroLeague by finishing last in its Top 16 group, with 3 wins in 14 games. Over 23 EuroLeague games played, Thompkins averaged 14.5 points and a third best in the league 8.1 rebounds per game. Nizhny Novgorod ended the competition in the VTB United League, after being eliminated by CSKA Moscow, by a 3–0 series sweep in the league's playoff semifinal series.

Thompkins leveled out in his junior year statistically, while the Bulldogs eventually made it to the 2011 NCAA Men's Division I Basketball Tournament only to be eliminated 68-65 in the first round to the Washington Huskies. He was once again a first team All-SEC selection.

Thompkins announced that he would leave Georgia and forgo his senior season to enter the 2011 NBA draft on April 5, 2011.

Thompkins represented the Under-19 United States national team at the 2009 Under-19 World Championship, which was held in New Zealand, and where the USA team won the gold medal. Over 9 tournament games, he averaged 10.6 points and 5 rebounds per game.

Considered a four-star recruit by Rivals.com, Thompkins was listed as the No. 11 power forward and the No. 30 player in the nation in 2008.

Thompkins attended the Wesleyan School in Peachtree Corners, Georgia. During his junior year, Thompkins decided to attend Oak Hill Academy where he averaged 15.8 points per game and 8.9 rebounds. For his senior season, Thompkins averaged 27.5 points and 14.7 rebounds for Wesleyan as they won the Georgia High School Association Class AA state championship. In May 2007, Thompkins committed to the University of Georgia for the 2008-2009 NCAA season despite offers from many other schools.

Howard Samuel "Trey" Thompkins III (born May 29, 1990) is an American professional basketball player for Real Madrid of the Liga ACB. Standing at 6 ft 10 in (2.08 m), he plays at the power forward position.

His father, Howard Thompkins Jr., played college basketball at Wagner College, and was later drafted by the Atlanta Hawks in 1981.