Alright - so I was missing a bunch of 'featured images' so I did a DB delete of a bunch of postmeta rows with the meta_key = "_thumbnail_id". Unfortunately, my query was a little greedier than I thought.
So I restored the rows that I deleted (I backed up those specific rows) but the thumbnails have not returned.
I'm no wordpress master, so I'm wondering if there is something else that I need to restore to get those references back.
_thumbnail_id
exist? Are you sure that the images exists in the path they are supposed to be?